Fitness Blog

Orifice Surgery: A potentially scarless surgical method:

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.

Yikes. I'm sure it sounds worse than it was. Other types of surgery:

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.

Many questions remain about the 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 surgery, 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.

Wonder how the infection rate compares? The vagina, mouth, and nose all have higher rates of bacterial colonization than the skin. I think they're still working out the details.

Could Be Better: The percentage of hospital emergency rooms prepared for bioterrorism.

Frame of Reference: Wondering what's most likely to kill you in the next ten years? Here are some risk charts to put things in perspective.

Transparency and Public Policy: R.W. Donnell notes some opacity in a recent research paper on healthcare insurance:

The methods session of the paper is no more open than the conflict of interest statement. We are told that “Interested readers can obtain the detailed protocol for this review from the corresponding author.” That’s right; you have to email the authors to get the search strategy. It would appear, though, that the search strategy was not predetermined; rather, it was “iterative”, almost as if they made it up as they went along. Then they culled the list of retrieved citations down from 4923 down to 38. We’re not told exactly how this was done or by whom, but it appears to have been a complicated procedure, and to the reader it’s somewhat mysterious.

There's more.

Into the Breach: The pneumonia vaccine has cut down significantly on the rate of invasive pneumococcal infections among native Alaskans, who for some reason are prone to more invasive forms of the disease. (Maybe Dr. Moalem could explain.) Or at least it had cut down on them until recently:

Researcher Rosalyn Singleton and her colleagues in the Centers for Disease Control and Prevention office in Anchorage found that invasive pneumococcal disease decreased 67 percent in Alaska Native children under age 2, and 61 percent in non-Native children of the same age between 2001 and 2003.

But evolving strains of bacteria not covered by the PCV7 vaccine cancelled those gains by 2006.

"The rapid success of PCV7 in Alaska has led to the near elimination of PCV7-serotype disease and the elimination of a health disparity for types covered by the vaccine," the authors wrote. "However, for Alaska Native children, there now exists a substantially elevated risk for IPD from serotypes not contained in PCV7.

How substantial is the increase? Very:

In the first 3 years after introduction of routine vaccination with heptavalent pneumococcal conjugate vaccine, overall invasive pneumococcal disease decreased 67% in Alaska Native children younger than 2 years (from 403.2 per 100,000 in 1995-2000 to 134.3 per 100,000 per year in 2001-2003.....). However, between 2001-2003 and 2004-2006, there was an 82% increase in invasive disease in Alaska Native children younger than 2 years to 244.6/100,000... Since 2004, the invasive pneumococcal disease rate caused by nonvaccine serotypes has increased 140% compared with the prevaccine period.

Getting rid of the vaccine-targeted pneumococci evidently made life better for their non-vaccine-targeted relatives. That evolutionary medicine idea is looking better all the time.