Study debunks longstanding medical myth that a torn ACL can’t heal

Personal trainer Danyelle Anderson ruptured the anterior cruciate ligament (ACL) in her right knee during a kickboxing class.

“My whole world came crashing down, pretty much,” she said.

She was told by an orthopaedic surgeon that it wasn’t possible for her ACL to heal and that a surgical reconstruction was needed.

Reluctant to have an operation, she decided to see if her knee would improve with physiotherapy.

Three months later, a follow-up MRI showed her injury had gone from a grade three complete rupture, where the ligament is torn completely in half, to a less severe grade one tear, where some of the fibres are continuous.

“So basically, my ACL has reattached and is healing,” she said.

Ms Anderson’s story comes as no surprise to University of Melbourne researcher Associate Professor Stephanie Filbay.

Stephanie Filbay’s study on ACL injuries has caused a stir in medical circles.(ABC News: Steven Martin)

In a study that has garnered worldwide attention, she re-analysed the results of a Swedish trial involving 120 patients, comparing the MRIs of those who had surgery with others who underwent rehabilitation without surgery.

“What we found, surprisingly, was that two years after injury, in those who’d had rehabilitation only, 53 per cent had signs of healing on MRI,” Dr Filbay said.

“Even more surprising was that those with signs of healing reported better outcomes than those who’d had ACL surgery.”

Evidence of healing was taken to be the presence of continuous ACL fibres where previous MRIs showed a complete disconnect in the rupture zone, as well as the ligament becoming thicker and tauter and taking on a more normal appearance.

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The findings have become a hot topic in medical circles, raising questions about whether changes are needed to the way doctors treat ACL injuries.

“Everyone’s heard of incidents where someone’s on a waitlist for surgery with a torn ACL and they get opened up by the surgeon and then the surgeon says ‘well, the ACL is healed’,” Dr Filbay said.

“People thought they were extremely rare, and what the research is suggesting is that this occurs more commonly than we thought.”

Challenging accepted medical wisdom

Some surgeons have reacted to the study with scepticism, pointing to the small number of young, physically fit adult patients involved in the trial, and the difficulties of assessing healing on an MRI.

A model of the bones of a human knee, with someone pointing out the position of the ACL with a pen.

Justin Roe points out the position of the ACL on a model of a knee.(ABC News: Jack Ailwood)

The ACL is a rope-like band of tissue that runs through the middle of the knee, connecting the thigh bone to the shin bone and playing a vital role in keeping the joint stable.

For decades, the accepted medical wisdom has been that the ACL can’t heal because of poor blood supply inside the knee joint.

“It has been a myth that the ACL never heals, something that’s been set in stone,” specialist orthopaedic knee surgeon Justin Roe said.

A man in medical scrubs and a cap sitting down inside a room, across from a journalist.

Justin Roe says it’s a myth that the ACL never heals on its own.(ABC News: Jack Ailwood)

In practice, he said, doctors have observed that ACLs heal in some cases, but not in others.

“And that’s the holy grail — predicting who it does heal in and who it doesn’t,” Dr Roe said.

Surgical reconstruction has been viewed as the gold standard treatment, offering a more predictable outcome.

“We have good surgical techniques that have developed over the years, so we can say with confidence to patients that with a successful ACL reconstruction, they can get back to sport 70 to 80 per cent of the time,” Dr Roe said.

Dr Filbay said her research showed that patients treated non-surgically returned to sport at similar rates.

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Conjoined Twins Fast Facts | CNN



CNN
 — 

Here’s a look at conjoined twins.

Conjoined twins are physically connected to one another at some point on their bodies.

Conjoined twins occur once every 200,000 live births, according to the University of Minnesota.

About 70% of conjoined twins are female.

Conjoined twins are identical – they are the same sex.

According to the Mayo Clinic, conjoined twins may be joined at any of these areas: chest, abdomen, spine, pelvis, trunk or head.

Scientists believe that conjoined twins develop from a single fertilized egg that fails to separate completely as it divides.

The term “Siamese twins” originated with Eng and Chang Bunker, a set of conjoined twins who were born in Siam (now Thailand) in 1811. They lived to age 63 and appeared in traveling exhibitions. Chang and Eng both married and fathered a total of 21 children between them.

In 1955, neurosurgeon Dr. Harold Voris of Mercy Hospital in Chicago performed the first successful procedure separating conjoined twins.

Lea and Tabea Block
Born August 9, 2003, in Lemgo, Germany, to Peter and Nelly Block. They are joined at the head. On September 16, 2004, the girls are separated. Tabea dies shortly thereafter.

Jade and Erin Buckles
Born February 26, 2004, to Melissa and Kevin Buckles at National Naval Medical Center in Bethesda, Maryland. They share a liver. On June 19, 2004, they are successfully separated.

Tatiana and Anastasia Dogaru
Born January 13, 2004, in Rome to Romanian parents Claudia and Alin Dogaru. They are connected at the head. In August 2007, doctors at University Hospital’s Rainbow Babies & Children’s Hospital in Cleveland announce that they will not perform a separation of the girls because the surgery is too risky.

Abbigail and Isabelle Carlsen
Born November 29, 2005, in Fargo, North Dakota, to Amy and Jesse Carlsen. They are joined at the abdomen and chest. On May 12, 2006, a team of 30 people, including 18 surgeons from various specialties at the Mayo Clinic in Rochester, Minnesota, perform a successful operation to separate the girls.

Regina and Renata Salinas Fierros
Born August 2, 2005, in Los Angeles to Sonia Fierros and Federico Salinas. Born facing each other and joined from the lower chest to the pelvis, they are fused in several places including the liver and genitals, and they share a large intestine. Regina is born with one kidney. On June 14, 2006, the twins are separated during a day-long surgery at Children’s Hospital Los Angeles.

Abygail and Madysen Fitterer
Born August 8, 2006, to Stacy and Suzy Fitterer from Bismarck, North Dakota. They are born joined at the abdomen and share a liver. On January 3, 2007, they are separated in a surgery at the Mayo Clinic.

Preslee Faith and Kylee Hope Wells
Born October 25, 2008, in Oklahoma City to Stevie Stewart and Kylie Wells. They are attached at the chest and are believed to be the first Native American conjoined twins. On January 19, 2009, they are separated at Children’s Hospital at OU Medical Center in Oklahoma City. On February 19, 2011, Preslee Faith dies.

Arthur and Heitor Rocha Brandao
Born April 2009 in Bahia, Brazil, to Eliane and Delson Rocha. They are joined at the hip and share a bladder, intestines, liver and genitals. The twins only have three legs between them. On February 24, 2015, the five-year-old twins undergo a 15-hour separation surgery after months of preparation. Arthur dies three days later after he suffers cardiac arrest.

Angelica and Angelina Sabuco
Born August 2009 in the Philippines to Fidel and Ginady Sabuco. They are joined at the chest and abdomen. On November 1, 2011, they are successfully separated after a 10-hour surgery at Lucile Packard Children’s Hospital in San Jose, California.

Hassan and Hussein Benhaffaf
Born December 2, 2009, in London to Angie and Azzedine Benhaffaf from East Cork, Ireland. They are attached at the chest but share no major organs. On April 8, 2010, they undergo a 14-hour separation surgery at Great Ormond Street Hospital. Both survive.

Maria and Teresa Tapia
Born April 8, 2010, in the Dominican Republic to Lisandra Sanatis and Marino Tapia. They are joined at the lower chest and abdomen and share a liver, pancreatic glands, and part of their small intestine. On November 8, 2011, they are successfully separated following a 20-hour procedure.

Joshua and Jacob Spates
Born January 24, 2011, in Memphis, Tennessee, to Adrienne Spates. They are joined back to back at the pelvis and lower spine, each with separate hearts, heads and limbs. On August 29, 2011, they are successfully separated after a 13-hour surgery. In October 2013, Jacob passes away.

Rital and Ritag Gaboura
Born September 22, 2010, in Khartoum, Sudan, to Abdelmajeed and Enas Gaboura. They are joined at the head. On August 15, 2011, they are successfully separated after a four-stage operation. Two operations took place in May, one in July and the final operation in August.

Allison June and Amelia Lee Tucker
Born March 1, 2012, to Shellie and Greg Tucker. They are attached at the lower chest and abdomen and share their chest wall, diaphragm, pericardium and liver. On November 7, 2012, they are successfully separated after a seven-hour surgery at Children’s Hospital Philadelphia.

A’zhari and A’zhiah Lawrence
Born October 10, 2012, in Virginia to Nachell Jones and Carlos Lawrence. They are joined from the chest to the abdomen and have a conjoined liver. On April 22, 2013, they are successfully separated following 14 hours of surgery. On October 14, 2013, A’zhari passes away.

Emmett and Owen Ezell
Born July 15, 2013, in Dallas to Jenni and Dave Ezell. They are joined at the liver and the intestine. On August 24, 2013, they are successfully separated.

Knatalye Hope and Adeline Faith Mata
Born April 11, 2014, in Houston to Elysse and John Matta. They are joined at the chest, sharing a liver, heart lining, diaphragm, intestines and colon. On February 17, 2015, a team of 12 surgeons separate the twins during a 26-hour procedure.

Erika and Eva Sandoval
Born August 10, 2014, in California to Aida and Arturo Sandoval. They are joined at the lower chest and upper abdomen and share a liver, bladder, two kidneys and three legs. On December 6-7, 2016, they are successfully separated after 17 hours of surgery at Lucile Packard Children’s Hospital Stanford in California.

Acen and Apio Akello
Born September 23, 2014, in Uganda to Ester Akello. They are joined at the hip and pelvis. On September 3, 2015, more than 30 medical specialists help separate the twins’ spinal cord during a 16-hour surgery at Nationwide Children’s Hospital in Ohio. To prepare for the surgery, medical specialists used 3-D printing to create anatomies similar to the girls.

Carter and Conner Mirabal
Born December 12, 2014, in Jacksonville, Florida, to Michelle Brantley and Bryan Mirabal. They are joined at the sternum and abdomen and share a liver and part of their small intestines. On May 7, 2015, the twins are successfully separated after 12 hours of surgery at Wolfson Children’s Hospital in Florida.

Scarlett and Ximena Torres
Born May 16, 2015, in Corpus Christi, Texas, to Silvia Hernandez and Raul Torres. Scarlett and Ximena are connected below the waist, sharing a colon and a bladder. On April 12, 2016, the twins are separated during a 12-hour procedure at the Driscoll Children’s Hospital in Texas.

Anias and Jadon McDonald
Born on September 9, 2015, in Chicago to Nicole and Christian McDonald. They are joined at the head. On October 13-14, 2016, Anias and Jadon are successfully separated after 27 hours of surgery at the Children’s Hospital at Montefiore Medical Center in New York.

Dawa and Nima Pelden
Born on July 13, 2017, in Bhutan to Bhumchu Zangmo. They are joined at the abdomen. On November 9, 2018, Dawa and Nima are successfully separated after a six-hour surgery at Melbourne Royal Children’s Hospital in Australia.

Safa and Marwa Ullah
Born January 7, 2017, in Pakistan to Zainab Bibi. They are joined at the head. On February 11, 2019, Safa and Marwa are successfully separated after 50 hours of surgery, that took place over a four month period, at London’s Great Ormond Street Hospital.

Ervina and Prefina Bangalo
Born June 29, 2018, in the Central African Republic to Ermine Nzutto. They share a skull and a majority of blood vessels. On June 5, 2020, the twins are successfully separated during an operation in Vatican City lasting 18 hours and involving 30 doctors and nurses.

Abigail and Micaela Bachinskiy
Born December 30, 2019, in Sacramento, California. The twins are joined at the head. On October 23-24, 2020, the twins are successfully separated during a 24-hour operation at UC Davis Children’s Hospital in Sacramento, California.

Siphosethu and Amahle Tyhalisi
Born January 30, 2021, in South Africa to Ntombikayise Tyhalisi. They are joined at the head. On February 24, 2021, the twins are successfully separated during an operation at Red Cross War Memorial Children’s Hospital in Cape Town.

Hassana and Hasina
Born in January 12, 2022 in Kaduna, Nigeria to Omar Rayano. They share an abdomen, pelvis, liver, intestines, urinary and reproductive system, and pelvic bones. On May 18, 2023 the twins are successfully separated during an operation at King Abdullah Specialized Children’s Hospital in Riyadh, Saudi Arabia.

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‘Am I dreaming?’: Double lung transplants save two people with late-stage cancer | CNN



CNN
 — 

Two people with stage IV lung cancer who had been told that they had only weeks or months to live are breathing freely after receiving double lung transplants, Northwestern Medicine in Chicago said Wednesday.

Lung cancer is the leading cause of cancer-related deaths in the United States. The American Cancer Society estimates that over 127,000 Americans will die from the disease this year.

It is considered stage IV once additional tumors have developed in the lungs, aside from the primary tumor, or the cancer has spread to more organs.

Someone diagnosed with stage IV lung cancer has limited treatment options, Northwestern Medicine says. A double lung transplantation offers a potentially lifesaving option for some people with a poor prognosis, but doctors say there are specific criteria a lung cancer patient must meet, including that the cancer is contained within the lungs and the person has tried all other treatment options.

In 2020, 54-year-old Albert Khoury of Chicago received a devastating lung cancer diagnosis.

Khoury, a cement finisher for the Chicago Department of Transportation, began to have back pain, sneezing and chills, along with coughing up blood, according to Northwestern Medicine. It was near the start of the Covid-19 pandemic, so at first, he thought he had coronavirus-related symptoms.

He was diagnosed with stage I lung cancer soon after.

Because of the pandemic, Khoury did not begin treatment until July 2020. At that point, the cancer had progressed to stage II and was continuing to grow, eventually reaching stage IV. He was told to consider hospice, special care for people near the end of their lives that focuses on comfort and support.

“I had a couple weeks to live,” Khoury said in a video released by the hospital. “Not that much time.”

His sister suggested that he reach out to Northwestern Medicine about the possibility of a double lung transplant.

“I need new lungs. That is the only hope to live,” Khoury said he told his doctor.

He met with an oncologist at Northwestern Medicine, who told him he should try additional treatments first. But not too long after, he was admitted to the intensive care unit with pneumonia and sepsis.

As his health declined, the oncologists began considering the rarely used procedure.

“His lungs were filled with cancer cells, and day by day, his oxygen was dropping,” said Dr. Young Chae, a medical oncologist at Northwestern Medicine who helped treat Khoury.

Transplant is typically considered for people with some form of lung cancer that has not spread to other parts of the body and for those who have tried all other treatment options and have limited time to live, according to Dr. Ankit Bharat, chief of thoracic surgery at the Northwestern Medicine Canning Thoracic Institute, who helped treat Khoury.

William Dahut, chief scientific officer at the American Cancer Society, also noted the importance of ensuring that cancer has not spread to other parts of the body before doing a transplant.

“There would need to be as much certainty as possible that the cancer is limited to the lungs, so whatever sort of extensive screening tests should be done … to ensure that there are no cancer cells outside of the lungs,” said Dahut, who was not involved in the care of either Northwestern patient.

The oncologists decided Khoury was eligible for the procedure. In September 2021, he spent about seven hours in surgery.

“Surgeons had to be extremely meticulous to not let trillions of cancer cells from the old lungs spill out into Khoury’s chest cavity or into his blood stream,” Northwestern Medicine noted in a news release.

The surgery is not without risk, Bharat said. In people with late-stage cancers, there is always a chance of it returning after the procedure.

“There is certainly the risk of potentially being in a worse off situation than they were,” he said. “So you go through a big surgery, and then you could very quickly have the cancer come back.”

Another risk is the treatment needed after a transplant, Dahut said.

All lung transplant recipients have to take medications to weaken their immune systems, which helps reduce the possibility of their body rejecting the organ – but also decreases its ability to fight off infection, according to the National Cancer Institute.

“Drugs that actually suppress your immune system put you at risk for infection afterwards but could even potentially put you at risk for second cancers afterwards,” Dahut said.

However, 18 months later, Khoury has not had any complications and is back to work.

His doctor showed him an X-ray of his chest with no signs of cancer. “When I saw that X-ray, I believed him,” Khoury said. “My body is in my hands now.”

The procedure was put to the test again last year, this time in a 64-year-old Minnesota woman.

Tannaz Ameli, a retired nurse from Minneapolis, had a persistent cough for several months. Her doctors did a chest X-ray and diagnosed her with pneumonia.

The illness lingered until she was told she had stage IV lung cancer in January 2022.

“There was no hope for my life at that point. They gave me … three months,” Ameli said in a video released by Northwestern Medicine.

She went through unsuccessful chemotherapy treatments and was told to consider hospice.

“I had no hope. I was ready for my life to end,” she said.

But her husband reached out to Northwestern Medicine about the option of a transplant. The oncologists found that Ameli fit their criteria, and she received a double lung transplant in July.

When she was told the procedure had made her cancer-free, she wondered, ” ‘Am I dreaming, sitting here? Can it happen?’ And it did happen.”

Ameli hasn’t had any complications, and she said the procedure has given her a new perspective on life.

“Every morning when I open my eyes, I just can’t believe it,” Ameli said. “Life has a different meaning now.”

Double lung transplants for cancer are rare due to the concern that the cancer may come back, Bharat said.

Historically, the surgery required sequential transplantations, but they are looking to alter the approach to lower the risk of recurrence, he said.

“Typically, what happens in a double lung transplant procedure is, we take one lung out, put the new one in, then take the second lung out and put the second lung in,” he said. “The concern is that when you take one lung out and put a new lung, the other lung is still attached, and they could cross-contaminate. … You could inadvertently have the cancer cells spread into the bloodstream.”

If cancer cells cross-contaminate or enter the bloodstream, there is a higher risk of cancer coming back.

Bharat and his team took a different approach with Khoury and Ameli: They opened the chest cavity and did a full heart and lung bypass.

“Essentially, what that means is, we don’t let any blood go through the heart and the lungs and bypass all of that,” Bharat said. “That allows us to then stop the blood flow to the lungs, which will prevent any cancer cells from going from the lung into the bloodstream.”

The surgeons gave Khoury and Ameli lung-shaped friendship necklaces Wednesday to mark their success.

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Most men with prostate cancer can avoid or delay harsh treatments, long-term study confirms | CNN



CNN
 — 

Most men who are diagnosed with prostate cancer can delay or avoid harsh treatments without harming their chances of survival, according to new results from a long-running study in the United Kingdom.

Men in the study who partnered with their doctors to keep a close eye on their low- to intermediate-risk prostate tumors – a strategy called surveillance or active monitoring – slashed their risk of the life-altering complications such as incontinence and erectile dysfunction that can follow aggressive treatment for the disease, but they were no more likely to die of their cancers than men who had surgery to remove their prostate or who were treated with hormone blockers and radiation.

“The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” about how to proceed, said lead study author Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford.

Other experts who were not involved in the research agreed that the study was reassuring for men who are diagnosed with prostate cancer and their doctors.

“When men are carefully evaluated and their risk assessed, you can delay or avoid treatment without missing the chance to cure in a large fraction of patients,” said Dr. Bruce Trock, a professor of urology, epidemiology and oncology at Johns Hopkins University.

The findings do not apply to men who have prostate cancers that are scored through testing to be high-risk and high-grade. These aggressive cancers, which account for about 15% of all prostate cancer diagnoses, still need prompt treatment, Hamdy said.

For others, however, the study adds to a growing body of evidence showing that surveillance of prostate cancers is often the right thing to do.

“What I take away from this is the safety of doing active monitoring in patients,” said Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic in Ohio, who reviewed the study, but was not involved in the research.

Results from the study were presented on Saturday at the European Association of Urology annual conference in Milan, Italy. Two studies on the data were also published in the New England Journal of Medicine and a companion journal, NEJM Evidence.

Prostate cancer is the second most common cancer in men in the United States, behind non-melanoma skin cancers. About 11% – or 1 in 9 – American men will be diagnosed with prostate cancer in their lifetime, and overall, about 2.5% – or 1 in 41 – will die from it, according to the National Cancer Institute. About $10 billion is spent treating prostate cancer in the US each year.

Most prostate cancers grow very slowly. It typically takes at least 10 years for a tumor confined to the prostate to cause significant symptoms.

The study, which has been running for more than two decades, confirms what many doctors and researchers have come to realize in the interim: The majority of prostate cancers picked up by blood tests that measure levels of a protein called prostate-specific antigen, or PSA, will not harm men during their lifetimes and don’t require treatment.

Dr. Oliver Sartor, medical director of the Tulane Cancer Center, said men should understand that a lot has changed over time, and doctors have refined their approach to diagnosis since the study began in 1999.

“I wanted to make clear that the way these patients are screened and biopsied and randomized is very, very different than how these same patients might be screened, biopsied and randomized today,” said Sartor, who wrote an editorial on the study but was not involved in the research.

He says the men included in the study were in the earliest stages of their cancer and were mostly low-risk.

Now, he says, doctors have more tools, including MRI imaging and genetic tests that can help guide treatment and minimize overdiagnosis.

The study authors say that to assuage concerns that their results might not be relevant to people today, they re-evaluated their patients using modern methods for grading prostate cancers. By those standards, about one-third of their patients would have intermediate or high-risk disease, something that didn’t change the conclusions.

When the study began in 1999, routine PSA screening for men was the norm. Many doctors encouraged annual PSA tests for their male patients over age 50.

PSA tests are sensitive but not specific. Cancer can raise PSA levels, but so can things like infections, sexual activity and even riding a bicycle. Elevated PSA tests require more evaluation, which can include imaging and biopsies to determine the cause. Most of the time, all that followup just isn’t worth it.

“It is generally thought that only about 30% of the individuals with an elevated PSA will actually have cancer, and of those that do have cancer, the majority don’t need to be treated,” Sartor said.

Over the years, studies and modeling have shown that using regular PSA tests to screen for prostate cancer can do more harm than good.

By some estimates, as many as 84% of men with prostate cancer identified through routine screening do not benefit from having their cancers detected because their cancer would not be fatal before they died of other causes.

Other studies have estimated about 1 to 2 in every five men diagnosed with prostate cancer is overtreated. The harms of overtreatment for prostate cancer are well-documented and include incontinence, erectile dysfunction and loss of sexual potency, as well as anxiety and depression.

In 2012, the influential US Preventive Services Task Force advised healthy men not to get PSA tests as part of their regular checkups, saying the harms of screening outweighed its benefits.

Now, the task force opts for a more individualized approach, saying men between the ages of 55 and 69 should make the decision to undergo periodic PSA testing after carefully weighing the risks and benefits with their doctor. They recommend against PSA-based screening for men over the age of 70.

The American Cancer Society endorses much the same approach, recommending that men at average risk have a conversation with their doctor about the risks and benefits beginning at age 50.

The trial has been following more than 1,600 men who were diagnosed with prostate cancer in the UK between 1999 and 2009. All the men had cancers that had not metastasized, or spread to other parts of their bodies.

When they joined, the men were randomly assigned to one of three groups: active monitoring or using regular blood tests to keep an eye on their PSA levels; radiotherapy, which used hormone-blockers and radiation to shrink tumors; and prostatectomy, or surgery to remove the prostate.

Men who were assigned monitoring could change groups during the study if their cancers progressed to the point that they needed more aggressive treatment.

Most of the men have been followed for around 15 years now, and for the most recent data analysis, researchers were able get follow-up information on 98% of the participants.

By 2020, 45 men – about 3% of the participants – had died of prostate cancer. There were no significant differences in prostate cancer deaths between the three groups.

Men in the active monitoring group were more likely to have their cancer progress and more likely to have it spread compared with the other groups. About 9% of men in the active monitoring group saw their cancer metastasize, compared with 5% in the two other groups.

Trock points out that even though it didn’t affect their overall survival, a spreading cancer isn’t an insignificant outcome. It can be painful and may require aggressive treatments to manage at that stage.

Active surveillance did have important benefits over surgery or radiation.

As they followed the men over 12 years, the researchers found that 1 in 4 to 1 in 5 of those who had prostate surgery needed to wear at least one pad a day to guard against urine leaks. That rate was twice as high as the other groups, said Dr. Jenny Donovan of the University of Bristol, who led the study on patient-reported outcomes after treatment.

Sexual function was affected, too. It’s natural for sexual function to decline in men with age, so by the end of the study, nearly all the men reported low sexual function, but their patterns of decline were different depending on their prostate cancer treatment, she said.

“The men who have surgery have low sexual function early on, and that continues. The men in the radiotherapy group see their sexual function drop, then have some recovery, but then their sexual function declines, and the active monitoring group declines slowly over time,” Donovan said.

Donovan said that when she presents her data to doctors, they point out how much has changed since the study started.

“Some people would say, ‘OK, yeah, but we’ve got all these new technologies now, new treatments,’ ” she said, such as intensity-modulated radiation therapy, brachytherapy and robot-assisted prostate surgeries, “but actually, other studies have shown that the effects on these functional outcomes are very similar to the effects that we see our study,” she said.

Both Donovan and Hamby feel the study’s conclusions still merit careful consideration by men and their doctors as they weigh treatment decisions.

“What we hope that clinicians will do is use these figures that we’ve produced in these papers and share them with the men so that newly diagnosed men with localized prostate cancer can really assess those tradeoffs,” Donovan said.

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When we’ll be able to 3D-print organs and who will be able to afford them | CNN

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CNN
 — 

What if doctors could just print a kidney, using cells from the patient, instead of having to find a donor match and hope the patient’s body doesn’t reject the transplanted kidney?

The soonest that could happen is in a decade, thanks to 3D organ bioprinting, said Jennifer Lewis, a professor at Harvard University’s Wyss Institute for Biologically Inspired Engineering. Organ bioprinting is the use of 3D-printing technologies to assemble multiple cell types, growth factors and biomaterials in a layer-by-layer fashion to produce bioartificial organs that ideally imitate their natural counterparts, according to a 2019 study.

This type of regenerative medicine is in the development stage, and the driving force behind this innovation is “real human need,” Lewis said.

In the United States, there are 106,800 men, women and children on the national organ transplant waiting list as of March 8, 2023, according to the Health Resources & Services Administration. However, living donors provide only around 6,000 organs per year on average, and there are about 8,000 deceased donors annually who each provide 3.5 organs on average.

The cause of this discrepancy is “a combination of people who undergo catastrophic health events, but their organs aren’t high enough quality to donate, or they’re not on the organ donor list to begin with, and the fact that it’s actually very difficult to find a good match” so the patient’s body doesn’t reject the transplanted organ, Lewis said.

And even though living donors are an option, “to do surgery on someone who doesn’t need it” is a big risk, said Dr. Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine. “So, living related donors are usually not the preferred way to go because then you’re taking an organ away from somebody else who may need it, especially now as we age longer.”

Atala and his colleagues were responsible for growing human bladders in a lab by hand in 2006, and implanting a complicated internal organ into people for the first time — saving the lives of three children in whom they implanted the bladders.

Every day, 17 people die waiting for an organ transplant, according to the Health Resources & Services Administration. And every 10 minutes, another person is added to the waitlist, the agency says. More than 90% of the people on the transplant list in 2021 needed a kidney.

“About a million people worldwide are in need of a kidney. So they have end-stage renal failure, and they have to go on dialysis,” Lewis said. “Once you go on dialysis, you have essentially five years to live, and every year, your mortality rate increases by 15%. Dialysis is very hard on your body. So this is really motivating to take on this grand challenge of printing organs.”

“Anti-hypertensive pills are not scarce. Everybody who needs them can get them,” Martine Rothblatt, CEO and chairman of United Therapeutics, said in June 2022 at the Life Itself conference, a health and wellness event presented in partnership with CNN. United Therapeutics was one of the conference sponsors.

“There is no practical reason why anybody who needs a kidney — or a lung, a heart, a liver — should not be able to get one,” she added. “We’re using technology to solve this problem.”

To begin the process of bioprinting an organ, doctors typically start with a patient’s own cells. They take a small needle biopsy of an organ or do a minimally invasive surgical procedure that removes a small piece of tissue, “less than half the size of a postage stamp,” Atala said. “By taking this small piece of tissue, we are able to tease cells apart (and) we grow and expand the cells outside the body.”

This growth happens inside a sterile incubator or bioreactor, a pressurized stainless steel vessel that helps the cells stay fed with nutrients — called “media” — the doctors feed them every 24 hours, since cells have their own metabolism, Lewis said. Each cell type has a different media, and the incubator or bioreactor acts as an oven-like device mimicking the internal temperature and oxygenation of the human body, Atala said.

“Then we mix it with this gel, which is like a glue,” Atala said. “Every organ in your body has the cells and the glue that holds it together. Basically, that’s also called ‘extracellular matrix.’”

This glue is Atala’s nickname for bioink, a printable mixture of living cells, water-rich molecules called hydrogels, and the media and growth factors that help the cells continue to proliferate and differentiate, Lewis said. The hydrogels mimic the human body’s extracellular matrix, which contains substances including proteins, collagen and hyaluronic acid.

The non-cell sample portion of the glue can be made in a lab, and “is going to have the same properties of the tissue you’re trying to replace,” Atala said.

The biomaterials used typically have to be nontoxic, biodegradable and biocompatible to avoid a negative immune response, Lewis said. Collagen and gelatin are two of the most common biomaterials used for bioprinting tissues or organs.

From there, doctors load each bioink — depending on how many cell types they’re wanting to print — into a printing chamber, “using a printhead and nozzle to extrude an ink and build the material up layer by layer,” Lewis said. Creating tissue with personalized properties is enabled by printers being programmed with a patient’s imaging data from X-rays or scans, Atala said.

“With a color printer you have several different cartridges, and each cartridge is printing a different color, and you come up with your (final) color,” Atala added. Bioprinting is the same; you’re just using cells instead of traditional inks.

How long the printing process takes depends on several factors, including the organ or tissue being printed, the fineness of the resolution and the number of printheads needed, Lewis said. But it typically lasts a few to several hours. The time from the biopsy to the implantation is about four to six weeks, Atala said.

A 3D printer seeds different types of cells onto a kidney scaffold at the Wake Forest Institute for Regenerative Medicine.

The ultimate challenge is “getting the organs to actually function as they should,” so accomplishing that “is the holy grail,” Lewis said.

“Just like if you were to harvest an organ from a donor, you have to immediately get that organ into a bioreactor and start perfusing it or the cells die,” she added. To perfuse an organ is to supply it with fluid, usually blood or a blood substitute, by circulating it through blood vessels or other channels.

Depending on the organ’s complexity, there is sometimes a need to mature the tissue further in a bioreactor or further drive connections, Lewis said. “There’s just a number of plumbing issues and challenges that have to be done in order to make that printed organ actually function like a human organ would in vivo (meaning in the body). And honestly, this has not been fully solved yet.”

Once a bioprinted organ is implanted into a patient, it will naturally degrade over time — which is OK since that’s how it’s designed to work.

“You’re probably wondering, ‘Well, then what happens to the tissue? Will it fall apart?’ Actually, no,” Atala said. “These glues dissolve, and the cells sense that the bridge is giving way; they sense that they don’t have a firm footing anymore. So cells do what they do in your very own body, which is to create their own bridge and create their own glue.”

Atala and Lewis are conservative in their estimates about the number of years remaining before fully functioning bioprinted organs can be implanted into humans.

“The field’s moving fast, but I mean, I think we’re talking about a decade plus, even with all of the tremendous progress that’s been made,” Lewis said.

“I learned so many years ago never to predict because you’ll always be wrong,” Atala said. “There’s so many factors in terms of manufacturing and the (US Food and Drug Administration regulation). At the end of the day, our interest, of course, is to make sure the technologies are safe for the patient above all.”

Whenever bioprinting organs becomes an available option, affordability for patients and their caregivers shouldn’t be an issue.

They’ll be “accessible for sure,” Atala said. “The costs associated with organ failures are very high. Just to keep a patient on dialysis is over a quarter of a million dollars per year, just to keep one patient on dialysis. So, it’s a lot cheaper to create an organ that you can implant into the patient.”

The average kidney transplant cost was $442,500 in 2020, according to research published by the American Society of Nephrology — while 3D printers retail for around a few thousand dollars to upward of $100,000, depending on their complexity. But even though low-cost printers are available, pricey parts of bioprinting can include maintaining cell banks for patients, culturing cells and safely handling biological materials, Lewis said.

Some of the major costs of current organ transplantation are “harvesting the organ from the donor, the transport costs and then, of course, the surgery that the recipient goes through, and then all the care and monitoring,” Lewis said. “Some of that cost would still be in play, even if it was bioprinted.”

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She flatlined three times, lost both legs and had a failing heart. Yet she told doctors she’s ‘the luckiest person on this planet’ | CNN



CNN
 — 

Her smile is bright, cheery, sometimes goofy and always contagious. But pictures can’t completely capture her upbeat, positive vibe. At 21, Claire Bridges has a mature spirit that amazes those who love her as well as the doctors who had to operate on her heart and remove both legs to save her life.

“She had a will to live, perseverance and a sort of twinkle in her eye — I tell all my patients that’s half the battle,” said Dr. Dean Arnaoutakis, a vascular surgeon at the University of South Florida Health in Tampa who amputated Bridges’ legs after complications from Covid-19.

“Most people would be despondent and feel like life had cheated them,” said Dr. Ismail El-Hamamsy, a professor of cardiovascular surgery at the Icahn School of Medicine at Mount Sinai in New York City, who operated on Bridges’ heart.

“But she told me, ‘I feel like I’m the luckiest person on this planet. I have my whole life ahead of me. I can have kids, a future, so many things to look forward to.’

“There was not once that I looked into her eyes that I didn’t feel her positiveness was true and genuine,” he said. “Claire’s story is one of just incredible resilience and positivity.”

Bridges left the hospital on her 21st birthday, more than two months after being admitted. Here she is with her brother Will.

In January 2022, Bridges was a 20-year-old model with her own apartment, a gaggle of friends and a part-time job as a bartender in St. Petersburg, Florida. She was a vegan and “exceptionally healthy,” according to her mother, Kimberly Smith.

When she caught Covid-19 that month, no one expected her be hospitalized. She was fully vaccinated and boosted.

But Bridges had been born with a common genetic heart defect: aortic valve stenosis, a mutation of the valve in the heart’s main artery, the aorta. Instead of having three cusps, or flaps, that let oxygen-rich blood flow from the heart into the aorta and to the rest of the body, people with aortic valve stenosis are often born with just two. The condition makes the heart work extremely hard to do its job, often causing breathlessness, dizziness and fatigue.

“I could work out and stuff, but I could never play sports,” she told CNN. “I couldn’t run. I couldn’t overexert myself.”

Her mom added, “We could really tell she began to learn her limits as she got older — she would get out of breath, stop and take a break.”

Before her surgeries, Bridges enjoyed roller-skating.

Whether due to her heart or another unknown reason, Covid-19 hit Bridges hard. Her health quickly spiraled out of control.

“Extreme fatigue, cold sweats — progressively every single day it would get harder to try to eat or drink anything,” she recalled. “Then one day my mom found me unresponsive and rushed me to the hospital. I flatlined three times that night.”

Bridges was put on dialysis, a ventilator and an exterior pump for her failing heart. She slipped into psychosis.

“I was thinking that everyone was trying to kill me, but I was holding on,” she said, adding that she then saw a bright light and her late grandfather.

“He was sitting on a bench, fishing, and he was wearing a baseball cap,” she said. “Then I saw my parents through a window. I don’t know if I actually did or if it was in my delusion, but I thought, ‘I can’t leave them like this.’ And my body just literally wouldn’t give up.”

While Bridges’ spirit battled on, doctors struggled to save her life. Her organs began to shut down, further weakening her frail heart. Blood wasn’t reaching her extremities, and tissues in both legs began to die.

Surgeons tried to save as much of her legs as possible. First, they opened tissue in both legs to reduce swelling, then amputated one ankle. Finally, there was no choice: Both legs had to be removed.

Doctors gathered around her bed to break the news.

“I remember looking up at them and saying, ‘Well, thank you for saving my life. And oh, can I have bionic legs?’ ” Bridges said.

“Everyone was totally shocked that she was taking it so well,” Smith recalled about her daughter. “But my entire family knew that if this tragedy had to happen to any of us, it would be Claire who would handle it the best. Upbeat and positive, that’s Claire.”

Bridges had a successful modeling career before she contracted Covid-19.

Losing her legs was only part of Bridges’ struggle back to health. “There were so many things that she could have died from while she was in the hospital,” Smith said.

Malnourished, Bridges was put on a feeding tube. She vomited, rupturing part of her small intestine, and “nearly bled out,” Smith said. To save her, doctors had to do an emergency transfusion — a dangerous procedure due to her weak heart.

“She almost died while getting the emergency transfusion because they had to pump the blood in so fast,” Smith said. “Then the next day she bled again, but they caught it in time.”

Bridges developed refeeding syndrome, a condition in which electrolytes, minerals and other vital fluids in a malnourished body are thrown out of balance when food is reintroduced, causing seizures, muscle and heart weakness, and a coma in some cases. Without quick treatment, it can lead to organ failure and death.

In another blow, her hair began to fall out, likely due to the loss of proper nutrition. Her family and friends came to her rescue.

“I knew that the only way to stop me from sobbing every time I pulled chunks of hair out of my head was to just get rid of it all,” Bridges said. “I told my brother Drew I was thinking about shaving my head, and without missing a beat, he immediately looked at me and said, ‘I’ll shave mine with you.’

“Then it snowballed into everyone telling me they would shave their heads, too,” Bridges said with a smile. “It was actually an extremely sweet, fun and freeing time — plus I’ve always wanted to shave my head, so I got to cross it off my bucket list!”

First row (from left):  Luba Omelchenko, a friend, and Claire Bridges.
Second row (from left):  Andy Beaty, a friend; Jaye Scoggins, Beaty's mother; Anna Bridges-Brown, Claire's sister; and Kimberly Smith, Claire's mother. 
Third row: Kristen Graham, a friend who shaved everyone's heads.

Bridges credits her friends and family — along with members of the community who organized fundraisers or reached out on social media — for her upbeat attitude throughout the ordeal.

“I am very blessed to have such an amazing family and also friends and people in my community that are like family,” she said. “People I didn’t know, people that I haven’t spoken to since elementary school or high school were reaching out to me.

“Yes, I allowed myself to grieve, and there were dark days. But honestly, my friends and my family surrounded me with so much love that I never had a second to really think negatively about my legs or how I look now.”

Bridges’ heart presented another hurdle: Already frail before her prolonged illness, it was now severely damaged. She needed a new valve in her aorta, and soon.

“We always knew Claire would need an open-heart surgery at some point,” her mother said. “Doctors wanted her as old as possible before they replaced the valve because the older you are, the bigger you are, and there’s less chance of needing another operation soon after.”

Bridges with her modeling agent, Kira Alexander. Bridges lost nearly 70 pounds during her hospitalization.

Her doctors reached out to Mount Sinai’s El-Hamamsy, an expert in a more complicated form of aortic valve replacement called the Ross procedure.

“Anybody who has an anticipated life expectancy of 20 years or more is definitely a potential candidate for the Ross,” El-Hamamsy said, “and it’s a perfect solution for many young people like Claire.”

Unlike more traditional surgeries that replace the malfunctioning aortic valve with a mechanical or cadaver version, the Ross procedure uses the patient’s own pulmonary valve, which is “a mirror image of a normal aortic valve with three cusps,” El-Hamamsy said.

“It’s a living valve, and like any living thing, it’s adaptable,” the surgeon said. “It becomes like a new aortic valve and performs all the very sophisticated functions that a normal aortic valve would do.”

The pulmonary valve is then replaced with a donor from a cadaver, “where it matters a little less because the pressures and the stresses on the pulmonary side are much lower,” he said.

Bridges with Dr. Ismail El-Hamamsy, the surgeon who replaced the failed valve in her heart.

The use of a replacement part from the patient’s own body for the aortic valve also eliminates the need for lifelong use of blood thinners and the ongoing risk of major hemorrhaging or clotting and stroke, El-Hamamsy said. And because the new valve is stronger than the malfunctioning valve it replaces, patients aren’t as likely to need future surgeries.

“Ross is the only replacement operation for the aortic valve that allows patients to have a normal life expectancy,” he said, “and a completely normal quality of life with no restrictions, no modifications to their lifestyle and a very good durability of the operation.”

The Ross procedure is more technically challenging than inserting a tissue valve or a mechanical valve, “some of the simplest operations that we as cardiac surgeons would ever do,” El-Hamamsy said.

Because the operation takes a high level of technical skill, it’s only available in a few surgical facilities at this time.

“It requires dedicated surgeons who want to commit their practice to the Ross procedure and who have the technical skills and expertise to do that,” he added. “Patients need to know they should be undergoing the surgery in a Ross-certified facility.”

When El-Hamamsy first met Bridges in a video call last spring, he wasn’t sure he would be able to do the surgery. Only 127 pounds before she got sick, Bridges had lost nearly 70 pounds during her hospitalization.

“She was so emaciated. There was no way I could take her into the operating room the way she was,” El-Hamamsy said. “I never expected that she would recover so quickly and keep her amazingly positive mentality.”

Slowly, over many months, Bridges fought her way back to health. In rehab, she began to learn to walk with prosthetic lower limbs. As she got stronger, she has continued one of her favorite activities — rock climbing.

Bridges climbs a rock wall using prosthetic limbs.

“At six months, I could hardly recognize her — she had gained weight back, her skin had fully healed over at the amputation sites, and she was a completely different-appearing person to the malnourished and debilitated girl I had met in the hospital,” said Arnaoutakis, the vascular surgeon.

The heart operation was successfully done in December. Today, Bridges is in the middle of cardiac rehabilitation and looking forward to being fitted for prosthetic blades — J-shaped, carbon-fiber lower limbs that will allow her to run on a track for the first time in her life.

She’s also returned to modeling, proud to show the world how well she has survived.

Bridges has returned to modeling after her surgeries.

El-Hamamsy isn’t surprised. “I told her from the day I met her on that Zoom, ‘It will be such a privilege to look after you because you’ve inspired me. I’ve never met a young person with this level of maturity and outlook on life.’

“I still think of Claire every once in a while when I bump into difficulty with life or whatever. It’s a reminder that happiness and positivity is a choice. Claire made that choice.”

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Some experts say more women should consider removing fallopian tubes to reduce cancer risk | CNN



CNN
 — 

“Knowledge is power,” says Samantha Carlucci, 26. The Ravena, New York, resident recently had a hysterectomy that included removing her fallopian tubes – and believes it saved her life.

The Ovarian Cancer Research Alliance is drawing attention to the role of fallopian tubes in many cases of ovarian cancer and now says more women, including those with average risk, should consider having their tubes removed to cut their cancer risk.

About 20,000 women in the US were diagnosed with ovarian cancer in 2022, according to the National Cancer Institute, and nearly 13,000 died.

Experts have not discovered a reliable screening test to detect the early stages of ovarian cancer, leading them to rely on symptom awareness to diagnose patients, according to OCRA.

Unfortunately, symptoms of ovarian cancer often don’t present themselves until the cancer has advanced, causing the disease to go undetected and undiagnosed until it’s progressed to a later stage.

“If we had a test to detect ovarian cancer at early stages, the outcome of patients would be significantly better,” said Dr. Oliver Dorigo, director of the division of gynecologic oncology in the Department of Obstetrics and Gynecology at Stanford University Medical Center.

Until such a test is widely available, some researchers and advocates suggest a different way to reduce the risk: opportunistic salpingectomy, the surgical removal of both fallopian tubes.

Research has found that nearly 70% of ovarian cancer begins in the fallopian tubes, according to the Ovarian Cancer Research Alliance.

Doctors have already been advising more high-risk women to have a salpingectomy. Several factors can raise risk, including genetic mutations, endometriosis or a family history of ovarian or breast cancer, according to the US Centers for Disease Control and Prevention.

If they accept that they won’t be able to get pregnant afterward and if they are already planning on having pelvic surgery, it can be “opportunistic.”

“We are really talking about instances where a surgeon would already be in the abdomen anyway,” such as during a hysterectomy, said Dr. Karen Lu, professor and chair of the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.

Although OCRA shifted its recommendation to include women with even an average risk of ovarian cancer, some experts continue to emphasize fallopian tube removal only for women with a high risk. Some are calling for more research on the procedure’s efficacy in women with an average risk.

Fallopian tubes are generally 4 to 5 inches long and about half an inch thick, according to Dorigo. During an opportunistic salpingectomy, both tubes are separated from the uterus and from a thin layer of tissue that extends along them from the uterus to the ovary.

The procedure can be done laparoscopically, with a thin instrument and a small incision, or through an open surgery, which involves a large incision across the abdomen.

The procedure adds roughly 15 minutes to any pelvic surgery, Dorigo said.

Unlike a total hysterectomy, in which a woman’s uterus, ovaries and fallopian tubes are removed, the removal of the tubes themselves does not affect the menstrual cycle and does not initiate menopause.

The risks associated with an opportunistic salpingectomy are also relatively low.

“Any surgery carries risk … so you do not want to enter any surgery without being thoughtful,” Lu said. “The risk of a salpingectomy to someone that is already undergoing surgery, though, I would say is minimal.”

Many women who have had the procedure say the benefit far outweighs the risk.

Carlucci had her fallopian tubes removed in January during a total hysterectomy, after testing positive for a genetic condition called Lynch syndrome that multiplied her risk of many kinds of cancers, including in the ovaries.

Several members of her family have died of colon and ovarian cancer, she said, and it prompted her to look into the available options.

Knowing that she could choose an opportunistic salpingectomy, which greatly decreased her chances of ovarian cancer, gave her hope.

As part of the total hysterectomy, it eliminated her risk of ovarian cancer.

“You can’t change your DNA, and no amount of dieting and exercise or medication is going to change it, and I felt horrible,” Carlucci said. “When I was given the news that this would 100% prevent me from ever having to deal with any ovarian cancer in my body, it was good to hear.”

Carlucci urges any woman with an average to high risk of ovarian cancer to talk to their doctor about the procedure.

“I know it seems scary, but this is something that you should do, or at the very least consider it,” she said. “It can bring so much relief knowing that you made a choice to keep you here for as long as possible.”

Monica Monfre Scantlebury, 45, of St. Paul, Minnesota, had a salpingectomy in March 2021 after witnessing a death related to breast and ovarian cancer in her family.

In 2018, Scantlebury’s sister was diagnosed with stage IV breast cancer at 27 years old.

“She went on to fight breast cancer,” Scantlebury said. “During the beginning of the pandemic, in March of 2020, she actually lost her battle to breast cancer at 29.”

During this period, Scantlebury herself found out that she was positive for BRCA1, a gene mutation that increases a person’s risk of breast cancer by 45% to 85% and the risk of ovarian cancer by 39% to 46%.

After meeting with her doctor and discussing her options, she decided to have a salpingectomy.

Her doctor told her she would remove the fallopian tubes and anything else of concern that she found during the procedure.

“When I woke up from surgery, she said there was something in my left ovary and that she had removed my left ovary and my fallopian tubes,” Scantlebury said.

Her doctor called about a week later and said there had been cancer cells in her left fallopian tube.

The salpingectomy had saved her life, the doctor said.

“We don’t have an easy way to be diagnosed until it is almost too late,” said Scantlebury, who went on to have a full hysterectomy. “This really saved my life and potentially has given me decades back that I might not have had.”

Audra Moran, president and CEO of the Ovarian Cancer Research Alliance, is sending one message to women: Know your risk.

Moran believes that if more women had the power of knowing their risk of ovarian cancer, more lives would be saved.

“Look at your family history. Have you had a history of ovarian cancer, breast cancer, colorectal or uterine in your family? Either side, male or female, father or mother?” Moran said. “If the answer is yes, then I would recommend talking to a doctor or talking to a genetic counselor.”

The alliance offers genetic testing resources on its website. A genetic counselor assess people’s risks for varying cancers based on inherited conditions, according to the US Bureau of Labor Statistics.

Carlucci and Scantlebury agree that understanding risk is key to preventing deaths among women.

“It’s my story. It’s her story. It’s my sister’s story … It is for all women,” Scantlebury said.

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Among seniors, Black men more likely to die after surgery than their peers, new study suggests | CNN



CNN
 — 

Among older patients, Black men may have a higher chance of dying within 30 days following surgery than their peers, according to a new study.

The study, published Wednesday in the medical journal BMJ, suggests that this inequity could be driven by outcomes following elective surgery, for which death was 50% higher for Black men than for White men – information that can be helpful for physicians as they plan procedures for patients.

Previously, separate research published in 2020 came to similar findings among children, showing that, within 30 days from their surgeries, Black children were more likely to die than White children.

“While a fair bit is known about such inequities, we find in our analyses that it’s specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries,” study lead Dr. Dan Ly, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles, said in a news release.

“Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States,” Ly said in the news release.

Researchers at the University of California, Los Angeles analyzed Medicare data on more than 1.8 million beneficiaries, ages 65 to 99, who underwent one of eight common surgical procedures. The data came from 2016 to 2018, and the researchers examined how many patients died during their hospital stay or within 30 days after surgery.

The researchers found that dying after surgery overall was higher in Black men compared with White men, White women, and Black women. Dying after surgery was 50% higher for Black men than for White men after elective surgeries, the data suggest, but for non-elective surgeries, there was no difference between Black and White men, although mortality was lower for women of both races.

Among the Black men in the study, about 3% of them died following surgery overall compared with 2.7% of White men, 2.4% of White women and 2.2% of Black women. These differences were relatively larger for elective surgeries, and appeared within a week after surgery and persisted for up to 60 days after surgery, the researchers found. In a separate analysis, the researchers found that Hispanic men and Hispanic women showed a lower overall mortality than Black men.

“Our study has shed light on the fact that Black men experience a higher death rate after elective surgery than other subgroups of race and sex. Further research is needed to understand better the factors contributing to this observation, and to inform efforts to develop interventions that could effectively eliminate such disparity,” Dr. Yusuke Tsugawa, the senior author of the study and associate professor of medicine at UCLA David Geffen School of Medicine, said in an email.

The study did not explore what could be driving the disparity but Tsugawa said that “several factors” could potentially play a role.

“The structural racism may at least partially explain our findings. For example, Black patients living in neighborhoods with predominantly Black residents tend to live close to hospitals that lack resources to provide high quality healthcare,” Tsugawa said in the email. “It is possible that Black men in particular face especially high cumulative amounts of stress and allostatic load, which refers to the cumulative burden of chronic stress and life events, potentially leading to a higher death rate after surgery among this population.”

The new study “validates” that racial inequities exist in health care, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the study.

“Obviously it’s concerning when you see such a large disparity,” Benjamin said, referring to the differences in how many patients died after surgery in the study findings.

“Here’s another example that these disparities are real, and I think it helps inform people – physicians, health systems, providers of care – that the disparity is already there,” he said. “So, when they’re looking at providing surgical care to their patients, they should be informed that, statistically, some of their patients may not do well 30 days out after surgery, and so they need to put extra care in both providing care and understanding the health status of those patients when they go to surgery.”

The new study findings also raise many questions about health systems and what happens when a patient is discharged home after surgery and their ability to safely recover from a procedure, said Dr. Utibe Essien, assistant professor of medicine at the David Geffen School of Medicine at UCLA, who was not involved in the study.

“As a generalist, I’m really thinking about that part as well and how we can engage with our surgical colleagues to make sure our patients who are from underrepresented groups are leading healthy lives after they’ve gone under the knife so to speak,” Essien said, adding that more research could help determine which types of elective surgeries may have seen more significant disparities than other types – and what would be needed to reduce the disparities.

“Would we find something different with more rare, complicated surgeries? It’s possible and that goes back to the type of hospitals where patients are getting their care,” Essien said.

“How close is a hospital really connected to an academic medical center that knows the latest and greatest surgical procedures? Do they have the technology to be able to do some really innovative and safe work?” he said. “Looking into ways at the hospital level that we can address these disparities, I think, is going to be important.”

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Beware the budget butt lift, regulators warn amid social media-inspired boom | CNN

In hindsight, Nikki Ruston said, she should have recognized the red flags.

The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted – and paid upfront – increased the day of the procedure, and she said she did not meet her surgeon until she was about to be placed under general anesthesia.

“I was ready to walk out,” said Ruston, 44, of Lake Alfred in Central Florida. “But I had paid everything.”

A few days after the July procedure, Ruston was hospitalized due to infection, blood loss, and nausea, her medical records show.

“I went cheap. That’s what I did,” Ruston recalled recently. “I looked for the lowest price, and I found him on Instagram.”

People like Ruston are commonly lured to office-based surgery centers in South Florida through social media marketing that makes Brazilian butt lifts and other cosmetic surgery look deceptively painless, safe, and affordable, say researchers, patient advocates, and surgeon groups.

Unlike ambulatory surgery centers and hospitals, where a patient might stay overnight for observation after treatment, office-based surgery centers offer procedures that don’t typically require an inpatient stay and are regulated as an extension of a doctor’s private practice.

But such surgical offices are often owned by corporations that can offer discount prices by contracting with surgeons who are incentivized to work on as many patients per day as possible, in as little time as possible, according to state regulators and physicians critical of the facilities.

Ruston said she now lives with constant pain, but for other patients a Brazilian butt lift cost them their lives. After a rash of deaths, and in the absence of national standards, Florida regulators were the first in the nation to enact rules in 2019 meant to make the procedures safer. More than three years later, data shows deaths still occur.

Patient advocates and some surgeons – including those who perform the procedure themselves – anticipate the problem will only get worse. Emergency restrictions imposed by the state’s medical board in June expired in September, and the corporate business model popularized in Miami is spreading to other cities.

“We’re seeing entities that have a strong footprint in low-cost, high-volume cosmetic surgery, based in South Florida, manifesting in other parts of the country,” said Dr. Bob Basu, a vice president of the American Society of Plastic Surgeons and a practicing physician in Houston.

During a Brazilian butt lift, fat is taken via liposuction from other areas of the body – such as the torso, back, or thighs – and injected into the buttocks. More than 61,000 buttock augmentation procedures, both butt lifts and implants, were performed nationwide in 2021, a 37% increase from the previous year, according to data from the Aesthetic Society, a trade group of plastic surgeons.

As with all surgery, complications can occur. Miami-Dade County’s medical examiner has documented nearly three dozen cosmetic surgery patient deaths since 2009, of which 26 resulted from a Brazilian butt lift. In each case, the person died from a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.

No national reporting system nor insurance code tracks outcomes and patient demographics for a Brazilian butt lift. About 3% of surgeons worldwide had a patient die as a result of the procedure, according to a 2017 report from an Aesthetic Surgery Education and Research Foundation task force.

Medical experts said the problem is driven, in part, by having medical professionals like physician assistants and nurse practitioners perform key parts of the butt lift instead of doctors. It’s also driven by a business model that is motivated by profit, not safety, and incentivizes surgeons to exceed the number of surgeries outlined in their contracts.

In May, after a fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed the state’s emergency rule to limit the number of butt lifts a surgeon could perform each day.

“I was getting sick of reading about women dying and seeing cases come before the board,” said Cairns, a physician and former member of the Florida Board of Medicine.

Some doctors performed as many as seven, according to disciplinary cases against surgeons prosecuted by the Florida Department of Health. The emergency rule limited them to no more than three, and required the use of an ultrasound to help surgeons lower the risk of a pulmonary fat clot.

But a group of physicians who perform Brazilian butt lifts in South Florida clapped back and formed Surgeons for Safety. They argued the new requirements would make the situation worse. Qualified doctors would have to do fewer procedures, they said, thus driving patients to dangerous medical professionals who don’t follow rules.

The group has since donated more than $350,000 to the state’s Republican Party, Republican candidates, and Republican political action committees, according to campaign contribution data from the Florida Department of State.

Surgeons for Safety declined KHN’s repeated interview requests. Although the group’s president, Dr. Constantino Mendieta, wrote in an August editorial that he agreed not all surgeons have followed the standard of care, he called the limits put on surgeons “arbitrary.” The rule sets “a historic precedent of controlling surgeons,” he said during a meeting with Florida’s medical board.

In January, Florida state Sen. Ileana Garcia, a Republican, filed a draft bill with the state legislature that proposes no limit on the number of Brazilian butt lifts a surgeon can perform in a day. Instead, it requires office surgery centers where the procedures are performed to staff one physician per patient and prohibits surgeons from working on more than one person at a time.

The bill would also allow surgeons to delegate some parts of the procedure to other clinicians under their direct supervision, and the surgeon must use an ultrasound.

Florida’s legislature convenes on March 7.

Consumers considering cosmetic procedures are urged to be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media platforms such as Facebook, Snapchat, and Instagram.

“That’s very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They’re excited about a low price and they forget about doing their homework,” he said.

The average price of a buttocks augmentation in 2021 was $4,000, according to data from the Aesthetic Society. But that’s only for the physician’s fee and does not cover anesthesia, operating room fees, prescriptions, or other expenses. A “safe” Brazilian butt lift, performed in an accredited facility and with proper aftercare, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons’ website.

Although Florida requires a physician’s license to perform liposuction on patients who are under general anesthesia, it’s common in the medical field for midlevel medical practitioners, such as physician assistants and nurse practitioners, to do the procedure in office settings, according to Dr. Mark Mofid, who co-authored the 2017 Aesthetic Surgery Education and Research Foundation task force study.

By relying on staffers who don’t have the same specialty training and get paid less, office-based surgeons can complete more butt lifts per day and charge a lower price.

“They’re doing all of them simultaneously in three or four different rooms, and it’s being staffed by one surgeon,” said Mofid, a plastic surgeon in San Diego, who added that he does not perform more than one Brazilian butt lift in a day. “The surgeon isn’t doing the actual case. It’s assistants.”

Basu said patients should ask whether their doctor holds privileges to perform the same procedure at a hospital or ambulatory surgery center, which have stricter rules than office surgery centers in terms of who can perform butt lifts and how they should be done.

People in search of bargains are reminded that cosmetic surgery can have other serious risks beyond the deadly fat clots, such as infection and organ puncture, plus problems with the kidneys, heart, and lungs.

Ruston’s surgery was performed by a board-certified plastic surgeon she said she found on Instagram. She was originally quoted $4,995, which she said she paid in full before surgery. But when she arrived in Miami, she said, the clinic tacked on fees for liposuction and for post-surgical garments and devices.

“I ended up having to pay, like, $8,000,” Ruston said. A few days after Ruston returned home to Lake Alfred, she said, she started to feel dizzy and weak and called 911.

Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss, and blood and abdominal infections, her medical records show.

“If I could go back in time,” she said, “I wouldn’t have had it done.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Weight loss surgery extends lives, study finds | CNN



CNN
 — 

Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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