Archive | October, 2011

New Technology May Encourage Doctors to Recommend Prostate Surgery

A new study finds that after hospitals in Wisconsin received robotic surgery technology, the number of prostate removals there doubled within three months.  In contrast, the number of prostate surgeries remained the same at hospitals that did not purchase this new two-million dollar technology.

This finding was published in the peer-reviewed journal Cancer. It comes just months after a Johns Hopkins report showing that hospital websites often hype robotic surgery without considering the risks and play up the benefits leading the study authors to worry that the new technology is encouraging doctors to recommend surgery to patients.

Each robot, in addition to the initial cost of nearly $2 million, requires more than $100,000 per year for maintenance.  Jim Hu, MD, director of urologic robotic surgery at Brigham and Women’s Hospital in Boston, who was not involved in the new study, suggested that hospitals that acquire this expensive technology might feel pressure to cover its costs by performing more surgeries.    The new technology is now used in almost three-quarters of all prostate removals nationwide.  Yair Lotan, MD, from the University of Texas Southwestern Medical Center at Dallas, who was not involved in the study, said that The bulk of evidence, however, does not show it to be more effective in saving lives than traditional surgery.

Joan Neuner, MD, MPh, of the Medical College of Wisconsin and colleagues found that between 2002 and 2008, Wisconsin hospitals performed more than 10,000 prostate removal surgeries. Almost one in four hospitals purchased surgical robots in that period.  Although fewer men had prostate cancer in 2007, there were 1,760 prostatectomies in 2007 compared to 1,400 in 2002.

Dr. Neuner and colleagues attribute these findings partly to patient demand, driven by aggressive marketing by manufacturers and hospitals.  Dr. Lotan reports that patients often request the robotic surgery without knowing the risks involved.  While shorter recovery times, less blood loss, and smaller scars are benefits of the robotic system, the technology extends the operation time. Dr. Hu emphasizes that the safety of surgeries depends more on the skills of the surgeon than on the technology involved.

Posted in Prostate HealthComments Off

Elimination of HLA-B Matching Policy Improves Number of Minority Kidney Transplant Matches

A recent study published in the American Journal of Transplantation reveals that since the elimination of the kidney allocation priority for matching for HLA-B on May 7, 2003, access to kidney transplantation for minorities has improved.  This policy reduced the requirements for tissue matching.  Previously, national kidney allocation rules provided priority to candidates who shared HLA-B antigens with potential decreased donors.

Improvements in medications used to prevent transplant rejection reduced the benefit that previously had been associated with HLA-B matching.  Matching for HLA-B also had the unintended consequence of reducing transplant opportunities for minority candidates.

The study was led by Valarie Ashby, MA, of The University of Michigan Kidney Epidemiology and Cost Center.  The research team reviewed outcomes before and after this change using data from the Scientific Registry of Transplant Recipients. Analyses were based on 108,701 solitary deceased donor kidney recipients during the six years before and after the policy change.  It found that since the change in the kidney allocation policy, minorities are now transplanted in proportion to the percentage by which they are added to the waiting list.  In the six years before and after the policy change, the overall number of deceased donor transplants rose 23%, with a larger increase for minorities (40%) and a smaller increase for non-Hispanic whites (8%).

Ashby emphasizes, “The current policy, which offers no allocation priority for HLA-B similarity and gives only one and two points for matches at HLA-Dr, has improved access to transplantation for all minority groups and has not been associated with a decrease in 2-year graft survival during the first six years following the policy change.”

Posted in Kidney HealthComments Off

Hormone Therapy Used to Treat Prostate Cancer Increases Vertebral Fractures

A recent study found that androgen deprivation therapy (ADT), a hormone therapy that is used to treat prostate cancer, speeds up loss of bone mineral density and increases vertebral fractures, particularly in white men.  The study was published in the Journal of Urology.

The men in the study were enrolled in a fracture prevention trial for prostate cancer patients receiving ADT and were at least 70 years old or had low bone mineral density at the lumbar spine or total hip.

Lead author of the study, Philip J. Saylor, MD, of Boston’s Massachusetts General Hospital, and his colleagues studied 1244 men, including 162 (13%) who had a vertebral fracture at baseline.  Although white race, osteoporosis and low bone density were significantly associated with this finding, age, country of residence and body mass index were not.  According to Saylor, older age, low bone mineral density, and white race prompt patients and doctors to discuss preventative therapy.

The duration of ADT was also not linked to prevalent vertebral fractures, perhaps because the effect on bone mineral density is most apparent in the first year of therapy and the average duration at study entry was four years.

The authors concluded the article by stating that these observations should inform the assessment and management of fracture risk among such men.  Also, in a related editorial, Paul Maroni and E. David Crawford, MDs, of the University of Colorado Health Sciences Center in Denver emphasized the importance of assessing bone health before ADT given the frequency and urgency of the condition.

Posted in Prostate HealthComments Off

IV Fluids Lowers Chances of Kidney Failure in Children

According to researchers at Washington University School of Medicine in St. Louis and other institutions, giving children intravenous fluids early in the course of an E. coli O157:H7 infection seems to lower the chances of developing severe kidney failure.  The results of this study were recently published in the Archives of Pediatric and Adolescent Medicine.

Children with E. coli O157:H7 have a high risk of hemolytic uremic syndrome (HUS), the most common cause of short-term, sudden-onset pediatric kidney failure.  Roughly 15 to 20 percent of children with this type of E. coli infection develop HUS.  Although most children recover and their kidneys heal, the syndrome can be fatal and might cause permanent kidney damage.

The first symptoms of E. coli O157:H7 are diarrhea and severe abdominal pain, and later symptoms include bloody diarrhea.  Kidney failure occurs because this strain of E. coli, called Shinga toxins, which hurt blood vessels. The kidneys are especially susceptible to the reduced blood flow that results from this injury. More than half of children with HUS develop kidney failure severe enough to require dialysis.

E. coli O157:H7 infection can come from eating undercooked hamburger, sprouts, unpasteurized fruit juices, dry-cured salami, lettuce, game meat and unpasteurized milk products, as well as exposure to contaminated water and contact with cattle. In the developed world, E. coli O157:H7 is the most common cause of acute kidney failure in otherwise healthy children.  The research team analyzed 50 children under 18 years old who were treated for diarrhea-associated HUS at 11 pediatric hospitals in the United States (St. Louis; Seattle; Sacramento, Calif.; Albuquerque, N.M.; Little Rock, Ark.; Milwaukee; Cincinnati and Columbus, Ohio; Indianapolis; and Memphis, Tenn.) and in Glasgow, Scotland.

Overall, 68 percent of the children stopped urinating. Of the 25 patients who had received no intravenous fluids in the first four days of illness, 84 percent stopped urinating. But in the other 25 patients who were given IV fluids to keep their kidneys working, only 52 percent stopped urinating.  Christina Ahn Hickey, MD, a third-year pediatrics resident at Washington University School of Medicine in St. Louis and St. Louis Children’s Hospital and the first author on the study, says that intravenous fluids are better for children than oral fluids because most of the children infected with E. coli O157:H7 are vomiting and having frequent bouts of diarrhea, so they cannot stay hydrated.

Posted in Kidney HealthComments Off