Scarfree surgery procedures explored
Mon, 30 Apr 2007 02:07:36 GMTBy MALCOLM RITTER, AP Science Writer
PITTSBURGH - A 4-year-old boy lay on an operating table here a few weeks ago with a tumor that had eaten into his brain and the base of his skull. Standard surgery would involve cutting open his face, leaving an ugly scar and hindering his facial growth as he matured.
But doctors at the University of Pittsburgh Medical Center knew a way to avoid those devastating consequences. They removed much of the tumor through the boy's nose.
Since then, doctors in New York and in France have announced they removed gall bladders through the vaginas of two women. And doctors in India say they have performed appendectomies through the mouth.
It's a startling concept and a little unpleasant to contemplate. But researchers are exploring new ways to do surgery using slender instruments through the body's natural openings, avoiding cutting through the skin and muscle.
Many questions remain about that approach. But doctors say it holds the promise of providing a faster recovery with less pain and no visible scars. And in the brain, it can avoid a need for manipulating tissue that could disturb brain and eye function.
For abdominal surgeries, going through the mouth, vagina or rectum would avoid the need to cut through sensitive tissues. And deep inside the body, where tissue doesn't feel lasting pain, the procedures themselves might be less traumatic.
Some abdominal surgeries like bowel operations can require patients to spend a week or more recovering at home. With the natural-opening surgery, the theoretical hope is that "they really can go back to work the next day," said Dr. David Rattner of Massachusetts General Hospital.
"It would be like going to the dentist and getting a root canal," Rattner said. "It's not trivial, but it also isn't disabling."
Sometimes doctors even pass up one natural body opening for another. On the same day they treated the 4-year-old, doctors in Pittsburgh operated on neck vertebrae of an elderly man through his nose. Usually, this operation would have been done through the mouth.
But going through the nose meant the patient could start eating right away rather than waiting a few days. And he avoided the risks of a feeding tube and a surgical hole in his throat to help him breathe, said neurosurgeon Dr. Amin Kassam.
Doctors at the medical center first reached the spine through the nose just two years ago, he said.
They have even removed brain tumors the size of baseballs through the nose, nibbling at them and withdrawing pieces the size of popcorn kernels.
However, entry through the nose isn't feasible for brain tumors in some locations. That's why doctors had to remove the rest of the 4-year-old's tumor another way, by going through the side of his skull. They used an incision designed to hide behind his hairline.
The key to operating through body openings is specialized slender instruments that can be inserted into the natural channels, along with devices that provide light and a video camera lens at the site of the surgery. Doctors watch their progress on video screens as they manipulate the surgical instruments.
Sound familiar? It's much like laparoscopic surgery, which revolutionized the operating room more than 15 years ago. For many operations, long incisions have been replaced with three or four holes, each maybe a quarter-inch to a half-inch wide. That has vastly reduced pain and recovery time.
The natural-opening approach holds the promise of going a step beyond that by eliminating the need for those punctures.
"Getting rid of them completely is going to be not an evolutionary step, but a revolutionary step," said Dr. Marc Bessler of New York-Presbyterian Hospital/Columbia University Medical Center.
He led the surgery in New York that detached and removed a woman's gall bladder through her vagina. The team also inserted laparoscopic instruments into two small incisions in her abdomen, using one instrument to hold tissue out of the way.
A week after that surgery was announced, a French doctor said his team had removed a woman's gall bladder through her vagina without any abdominal incisions. Instead, the team pierced her abdomen with a needle about a tenth of an inch wide. The needle was equipped with a video camera system and also allowed doctors to inflate the abdomen to create a working space.
The surgery, performed April 2 on a 30-year-old woman at University Hospital of Strasbourg, was led by Dr. Jacques Marescaux of the Institute for Research into Cancer of the Digestive System in Strasbourg. In a written statement, Marescaux said the procedure left no abdominal scar.
Meanwhile, surgeons have shown increasing interest in removing brain tumors through the nose over the last five years or so, noted Dr. Gail Rosseau, chief of surgery at the Neurologic-Orthopedic Institute of Chicago.
"This is the dawn of this phase of neurosurgery," said Rosseau, a spokeswoman for the American Association of Neurological Surgeons. "This is exciting, it's new and it may well be better for our patients. In fact, we hope it will be. But it does raise questions."
Cancers can come back if they're not completely removed, she noted. It's too soon to tell whether attacking tumors through the nose leads to a higher rate of cancer recurrence than going through the skull, she said. Concerns like the risk of meningitis from spinal fluid leakage also have to be addressed.
Today, most surgeons would go through the skull to remove baseball-sized tumors, she said, "but a decade from now? I don't know."
As for abdominal surgery, a few procedures have been done in people, but nearly all the research so far has been in animals. There are still plenty of questions and barriers to overcome.
For example, Rattner said, new tools must be developed to perform this kind of surgery. And while it makes sense that people would recover faster from natural-opening surgery than laparoscopic procedures, that hasn't been proven yet, Rattner said.
Then there's the basic question of just what abdominal procedures make sense for a natural-opening approach. For women, Bessler believes the gall bladder and appendix will be among those that will be removed through the vagina.
Rattner questions whether a natural-opening approach for removing those organs offers enough of an improvement over laparoscopy — which can get a patient back to work in four to seven days — to make it worthwhile.
He sees more potential for procedures that replace surgeries that can keep a person out of work for weeks, like removing a kidney, adrenal gland or a portion of the intestine. Or doing obesity surgery.
"It's not going to replace laparoscopic surgery, but it's going to have a niche somewhere," Rattner said. "We're trying to figure out where that niche is going to be."
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On the Net:
Abdominal surgery via natural openings: http://www.noscar.org
How meth took hold on Indian reservation
Sun, 29 Apr 2007 21:37:14 GMTBy ANGIE WAGNER, AP National Writer
WIND RIVER INDIAN RESERVATION, Wyo. - Just off the deserted highways, the silver pickup truck eases down quiet streets, its driver offering a numbing tour of a remote reservation framed by the beauty of snowcapped mountains.
There, Leon Tillman says, over there — the house on the right, a white, two-story building set off by itself. It used to be a big drug house. Now it's shuttered, its owners in prison.
A man dressed in an army green shirt and pants appears on the side of the road, his thumb up, looking for a ride. "That's a meth head," Tillman says. "He's bumming right now."
A few more drug houses and Tillman's tour of the despair of methamphetamine ends.
Not long ago, most people here had never even heard of meth. But today, most know someone on meth or in prison because of it. Tillman, 39, knows too many to count.
"It's everywhere," he said.
Indeed, American Indians have been especially hard hit by meth. Drug cartels have targeted Indian Country because the people are vulnerable, and law enforcement struggles to keep up.
But the story of how meth came to this remote reservation is really quite remarkable.
Like a cancer, a Mexican drug gang permeated the reservation and its families. It left behind a landscape strewn with broken lives.
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Some 12,000 Indians — members of the Northern Arapaho and the Eastern Shoshone tribes — live on 2.2 million acres, an area so vast many homes are separated by miles of barren land.
Poverty and unemployment are high, alcoholism is rampant and the police department is so understaffed — patrolling such a large area — that the average response time is 15 to 20 minutes.
Jesus Martin Sagaste-Cruz knew that. And he knew the reservation's isolation would be perfect for his business.
Authorities learned of the Sagaste-Cruz drug ring back in 1997. Sagaste-Cruz and his Mexican gang had already been selling around Indian reservations in South Dakota and Nebraska.
But it was an article in The Denver Post that changed the way they did business. The story talked about how a Nebraska liquor store near the Pine Ridge Reservation in South Dakota did millions of dollars in business. Sales were especially high immediately after Indians received their per capita checks — their share of their tribe's income.
Sagaste-Cruz figured if there were already so many Indians addicted to alcohol, it would be easy enough to addict them to methamphetamine.
So around 2000, the Mexicans moved in and near Wind River Reservation.
"They came to a place where people don't have anything," said Frances Monroe, who works in the Northern Arapaho Child Protection Services office.
They started with free meth samples. The men pursued Indian women, providing them with meth even as they romanced them and fathered their children. Eventually, the women needed to support their habit, so they became dealers, too — and they used free samples to recruit new customers.
It was all part of the plan.
For the next four years, the gang sold pounds and pounds of meth, much of it 98 percent pure. The drugs came from Mexico, then on to Los Angeles; Ogden, Utah ; and finally Wyoming, where gang members had a handful of local distributors, each with their own customer base.
Customers became dealers and recruiters, and their customers did the same.
Before, meth was barely mentioned on the reservation. Police reported only sporadic arrests.
But now the reservation was saturated with it. Crime soared. From 2003 to 2006, cases of child neglect increased 131 percent. Drug possession was up 163 percent; spousal abuse rose 218 percent.
The Wind River reservation is not alone. The Bureau of Indian Affairs found that methamphetamine was listed as the greatest threat to Indian communities by police departments.
Mexican drug cartels take advantage of the often complicated law enforcement jurisdictions in Indian Country. Isolated communities are hit the hardest, and sometimes even tribal leaders are not immune, said Heather Dawn Thompson, director of government affairs for the National Congress of American Indians.
Here on the Wind River, a tribal judge, Lynda Munnell-Noah, was arrested in a 2005 drug ring bust and accused of trying to assault and murder a Bureau of Indian Affairs law enforcement officer.
Resources are few, and most reservations don't have treatment centers. Between 2000 and 2005, the number of methamphetamine contacts in Indian Health Services facilities increased by almost 250 percent.
"Even if we arrest people for use or sale, there's almost nothing to do with them in order to help them recover," Thompson said. "Where do you go and how do you pay for it?"
In his 2008 budget, President Bush proposed a $16 million increase in law enforcement funding in Indian Country to help combat methamphetamine, a godsend to police departments like Wind River's, which has only 10 police officers.
"The heartbreaking part of it is, it's had this absolutely devastating effect on our community," Thompson said. "I have tribal leaders coming to my office all the time just crying. I mean, how do you fight this? How do you function as a government when 30 percent of your tribal employees are now using meth?"
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Inside a tribal office, a bulletin board displays meth's effects: In a series of mug shots, a woman deteriorates — her teeth rotting, her skin collecting scabs. A nearby poster warns that making, selling or using meth around a child will mean prison time.
This is a place where people mostly keep to themselves. They know meth is a huge problem, but they don't want to talk much about it. They fear retaliation.
A jury found that the Sagaste-Cruz ring had distributed more than 99 pounds of meth — an amount that had a street value of between $4.5 to $6.8 million, according to the Drug Enforcement Administration. The gang also sold meth on the Rosebud, Pine Ridge and Yankton reservations in South Dakota and Santee Sioux reservation in Nebraska, authorities found.
Sagaste-Cruz and 22 other people were given prison time — a life sentence, in Sagaste-Cruz' case. His brother, Julio Caesar Sagaste-Cruz, remains a fugitive.
Ask people on the reservation about the Sagaste-Cruz case and most don't know much about it. They seem surprised to learn how sophisticated the operation was.
But mention the Goodman case, and everyone knows. The Goodmans were an entire family, grandparents down to grandchildren, who were dealing meth and prescription drugs here.
Nineteen people, including the tribal judge, were arrested in 2005.
The two cases weren't directly related, but with many Indians already hooked on meth compliments of the Sagaste-Cruz gang, the Goodmans didn't have any trouble finding customers. Assistant U.S. Attorney Kelly Rankin said the Goodmans often had 20 to 50 customers a day come to their house.
Darrell LoneBear Sr., whose sister, Donna Goodman, and her husband, John Goodman, were the ring's leaders, said his relatives fell victim to easy money on a reservation where jobs are hard to find.
He rattles off his family's prison sentences: "John Goodman, 21 years. My sister Donna, 24 years. My nephew James got 19 years. My nephew Darrell got 8.
"It was all of my family," he said.
Thirteen children were sent to live with other relatives. One sister took in six children, another took in three.
"It is a tremendous, added responsibility emotionally and financially," said LoneBear, crime prevention and safety supervisor for the Northern Arapaho Tribal Housing. "All of us have been traumatized by this matter. We all still stay here."
Police Chief Doug Noseep has a police force that can't possibly keep up with every call. He is grateful for the help from outside law enforcement agencies in the raids over the past few years, and believes it has reduced the amount of meth here.
Noseep knows who is trying to get help, who is still using. Once, his officers encountered a 12-year-old girl who was addicted.
"It's sad as hell," he said. "It's here and it's not going to go anywhere. It's never going to go away."
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Seven years after the Sagaste-Cruz gang arrived, meth rolls on: Last summer, another bust at Wind River resulted in 43 arrests, the largest drug bust in the history of Wyoming.
On a recent night, Partners Against Meth met at a local school. The group struggles to attract volunteers and to keep committees on track. But here families that have been struck hard by the meth epidemic, and those that want to learn more about it, can come together to talk.
Leon Tillman brought his wife, son and daughter. He told the group he has six relatives in prison for meth or alcohol charges. "That's one of my worst fears, is to have one of my kids on drugs. I want to at least say I tried," he said.
A few years ago, John Washakie noticed his daughter, now 27, was losing weight and locking herself in her bedroom at her house. Then, one night, she dropped off her three young children at his house and disappeared into the darkness.
He cared for the kids for three years. It wasn't easy. "They lose all their energy about life. You spend a lot of time dealing with their emotions," he said.
Today, his daughter is clean, and cares for her children, now numbering five, herself.
"I think there are a lot of people that are scared to tell you the truth," the grandfather said. "You don't walk away from this."
New toys read brain waves
Sun, 29 Apr 2007 22:48:27 GMTBy RACHEL KONRAD, AP Technology Writer
SAN JOSE, Calif. - A convincing twin of Darth Vader stalks the beige cubicles of a Silicon Valley office, complete with ominous black mask, cape and light saber.
But this is no chintzy Halloween costume. It's a prototype, years in the making, of a toy that incorporates brain wave-reading technology.
Behind the mask is a sensor that touches the user's forehead and reads the brain's electrical signals, then sends them to a wireless receiver inside the saber, which lights up when the user is concentrating. The player maintains focus by channeling thoughts on any fixed mental image, or thinking specifically about keeping the light sword on. When the mind wanders, the wand goes dark.
Engineers at NeuroSky Inc. have big plans for brain wave-reading toys and video games. They say the simple Darth Vader game — a relatively crude biofeedback device cloaked in gimmicky garb — portends the coming of more sophisticated devices that could revolutionize the way people play.
Technology from NeuroSky and other startups could make video games more mentally stimulating and realistic. It could even enable players to control video game characters or avatars in virtual worlds with nothing but their thoughts.
Adding biofeedback to "Tiger Woods PGA Tour," for instance, could mean that only those players who muster Zen-like concentration could nail a put. In the popular action game "Grand Theft Auto," players who become nervous or frightened would have worse aim than those who remain relaxed and focused.
NeuroSky's prototype measures a person's baseline brain-wave activity, including signals that relate to concentration, relaxation and anxiety. The technology ranks performance in each category on a scale of 1 to 100, and the numbers change as a person thinks about relaxing images, focuses intently, or gets kicked, interrupted or otherwise distracted.
The technology is similar to more sensitive, expensive equipment that athletes use to achieve peak performance. Koo Hyoung Lee, a NeuroSky co-founder from http://www.neurosky.com
Emotiv Systems Inc.: http://www.emotiv.com
CyberLearning Technology LLC: http://www.smartbraingames.com
KFC to switch to oil with no trans fat
Mon, 30 Apr 2007 05:55:34 GMTBy BRUCE SCHREINER, Associated Press Writer
LOUISVILLE, Ky. - KFC's fried chicken buckets soon will be stamped with a health message along with the famous likeness of its founder, Colonel Harland Sanders.
The banner proclaims that its chicken has zero grams of trans fat per serving.
The Louisville-based chain announced Monday that all 5,500 of its U.S. restaurants have stopped frying chicken in artery-clogging trans fat. The company had said in October that it was switching to a new soybean oil believed to be less likely to cause heart disease.
"This idea is a positive one for consumers, and we do expect it's going to really appeal to people and bring them into our stores," said James O'Reilly, KFC's chief marketing officer.
Sister brand Taco Bell also said Monday that its U.S. restaurants have completely switched to an oil with zero grams of trans fat. All 4,200 single-brand Taco Bells were converted to a canola oil, and all 1,400 multibrand locations switched to a soybean oil, the fast food chain said.
There are 23 Taco Bell items that contain no trans fat, including the chicken and beef crunchy taco, grilled steak soft taco, chicken and steak Gordita Supreme, and the chicken and steak Chalupa Supreme. Taco Bell said it's working to remove all trans fat from all its ingredients.
The two chains are subsidiaries of Louisville-based Yum Brands Inc., whose brands also include Pizza Hut, Long John Silver's and A&W All-American Food Restaurants.
The announcements come amid a national push to rid diets of trans fat. New York City and Philadelphia have required restaurants to phase out trans fat by next year, and bills to restrict or ban trans fat in restaurants or school cafeterias have been introduced in a number of states. Doctors say trans fat — listed on food labels as partially hydrogenated vegetable oil — can raise bad cholesterol and lower healthy cholesterol.
Other companies including Wendy's International Inc., Starbucks Corp., McDonald's Corp. and Burger King Holdings Inc. have also said they will phase out trans fat from their products.
KFC said the change in cooking oils will not change how its fried chicken tastes.
"We have safeguarded the recipe and the flavor profile," said Doug Hasselo, KFC's chief food innovation officer.
Hasselo said the new cooking oil costs more, but the chain will absorb the extra expense without passing it along to customers.
The zero grams trans fat items at KFC also include its potato wedges. Some of KFC's non-fried items still contain trans fat, including biscuits, pot pies, macaroni and cheese, and some desserts. The company said it's working to remove trans fat from those items.
KFC was unveiling television advertising Monday to promote its switch to cooking oil without trans fat. KFC stores will put up signs touting the conversion, and the chicken buckets will carry the health message within a week or two.
The company won praise from the Center for Science in the Public Interest, a consumer group that pushed for KFC to switch to a healthier cooking oil.
"To get rid of this one major problem improves their customers' health automatically, without the consumers doing anything," said Michael Jacobson, the group's executive director.
Customers at a KFC restaurant in the chain's hometown said they appreciated the change.
Steve Garber, part of a recent lunch crowd, said he worries more about his diet.
"I'm in my 40s now, so it's important that I try to take better care of myself," said Garber, 41, of Clarksville, Ind.
Larry Miller, a restaurant analyst with RBC Capital Markets, said the biggest impact would be a perception that "maybe KFC is a little bit more healthy than it otherwise would have been. But fried chicken is fried chicken. How healthy is it going to be in people's minds?"
Half of Spaniards overweight ministerial study
Mon, 30 Apr 2007 17:03:48 GMTMADRID - More than half of the adult population of Spain and one in four youngsters are overweight or obese, according to a ministry of health study released Monday.
&;Fifty two percent of the adult population and 27.6 percent of children are either overweight or obese,&; the ministry said as it unveiled the results of a 2006 study into the state of the nation's health.
The results, based on the height and weight of respondants interviewed in 31,000 households nationwide, showed that 15.5 percent of men and 15 percent of women were obese and that 44.4 percent of men and 30.3 percent of women were overweight.
A 2005 study showed 49.52 percent of all adults were either overweight or obese.
Of children interviewed in the latest study, 9.1 percent of those aged between two and 17 were obese and 18.5 percent were overweight, compared with 8.5 and 18.2 percent a year earlier.
That puts Spain up with Britain as one of the worst-affected nations in Europe.
Obesity raises the risk of heart disease, diabetes and some cancers. Being overweight increases blood pressure and cholesterol levels which can lead to heart disease.
Nonetheless, 68.8 percent of those surveyed judged their health to be good or very good.
