Minimally invasive elective repairs of abdominal aortic aneurysms, potential deadly bulges in arteries, reduces vessel rupture and short-term, AAA-related mortality, according to a Beth Israel Deaconess Medical Center study.
Endovascular abdominal aortic repair (EVAR), where surgeons use stents to repair damaged blood vessels, was first introduced in 1999 and has resulted in lower rates of death and complications than open surgical repair. It has allowed surgeons to offer the elective procedure for patients considered at too much risk for the traditional open repair and, when combined with increased detection, may be responsible for the increased numbers for repairs before the vessel ruptures.
Surgeons have been concerned, however, that EVAR may not be as effective in preventing late ruptures leading to potentially increased mortality after repair.
In a retrospective observational study of 338,278 Medicare patients undergoing intact repair between 1995 and 2008, BIDMC researchers found a decline in ruptures, with or without repair in all age groups, with a decline in operative mortality in both elective and emergent repairs.
‘The introduction of EVAR, combined with advanced abdominal imaging, may be responsible for an increasing number of intact AAA repairs in the United States, which should ultimately result in lower mortality from AAA rupture,’ says lead author Marc L. Schermerhorn, MD, Chief of the Division of Vascular and Endovascular Surgery within the Roberta and Stephen R. Weiner Department of Surgery at BIDMC and an Associate Professor of Medicine at Harvard Medical School.
The study found the overall rate of intact repair, adjusted for age and gender, increased from 79.9 to 85.0 per 100,000 Medicare beneficiaries during the study period. The rate decreased for those age 65-74, but increased in all other age groups, particularly for those age 80 and above.
The proportion of intact repairs using EVAR increased steadily over time, reaching 77 percent in 2008 for all age groups and 83 percent for patients over the age of 80.
Operative mortality with intact repair declined over time after the introduction of EVAR, with the greatest reduction for patients 80 and older. The overall rate of short-term AAA-related deaths for patients presenting at a hospital declined from 26.1 to 12.1 per 100,000 Medicare beneficiaries, mostly due to a 50 percent decline in the rate of ruptures and resulting deaths.
Schermerhorn noted several key findings, including a dramatic increase in intact AAA repairs in patients over 80

A new caesarean simulator called Desperate Debra is being launched by the Trust, in collaboration with NHS Fife and Adam,Rouilly Ltd. Desperate Debra is the first simulator used to train doctors in dealing with late-stage (emergency) caesareans, which affect around 20,000 births per year in the UK and can be life-threatening for both mother and baby.
During emergency caesareans, the baby

Only in certain cases are recurrences detected more reliably than with conventional techniques. Due to the lack of studies, there is currently no proof that patients with ovarian cancer can benefit from positron emission tomography (PET) alone or in combination with computed tomography (CT). As regards diagnostic accuracy, in certain cases, recurrences can be detected earlier and more accurately with PET or PET/CT than with conventional imaging techniques. This is the conclusion of the final report by the German Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne that was published on 23 May 2012.

Ovarian cancer is the fifth most common malignant tumour in women. Every year 15.9 women in every 100,000 are diagnosed with the disease in Germany and it claims the lives of 8 in 100,000 women per year. Since the ovaries lie deep in the abdomen and an ovarian tumour normally causes no symptoms for a long time, it is often only discovered at a late stage.

Many experts hope that an investigation using PET or PET/CT alone or in combination with other methods would be better able to distinguish between benign and malignant tumours when ovarian cancer is suspected. It could also help classify cancerous tumours into the correct stage, make it easier to assess whether they respond to treatment and to show earlier and with greater certainty whether a recurrence or secondary tumour (metastasis) has occurred. This information should then enable patients to be given better treatment recommendations.

IQWiG therefore searched the international literature for studies investigating the effects of diagnosis using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of this research – and an appropriately tailored treatment – could contribute to patients having better chances of survival, spare them unnecessary operations or other diagnostic procedures, or improve their quality of life. However, the search for such studies was unsuccessful, so the question as to the patient-relevant benefit of PET or PET/CT had to remain unanswered.

In addition, IQWiG searched for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT were compared with other diagnostic methods. The basic question is how often a PET investigation gives a correct result. On the one hand, it should overlook true, cancerous tumours as rarely as possible, but on the other, it should not awake any false suspicions.

The results of a total of 40 individual studies on this topic were evaluated. However, these studies permit a robust conclusion only in respect of the detection (or exclusion) of a recurrence, where PET or PET/CT appears to be more reliable than other methods. Nevertheless, it remains unclear whether this only applies to patients in whom symptoms (e.g. pain) have already occurred, or also to those in whom routine screening has shown an abnormal blood test result. This is because only very few studies give precise details on this point.

Since even the above patients have not been investigated to determine whether the higher test accuracy of PET or PET/CT has positive effects on mortality, the burden of disease or the quality of life, IQWiG assumes that a patient-relevant benefit of PET or PET/CT is not proven. For instance, it is particularly questionable whether a recurrence detected by PET or PET/CT can actually be better treated – and the patient thereby has a noticeable advantage.

It is therefore essential that doctors fully inform their patients not only of the possible benefits in the form of an earlier diagnosis, but also of the possible harms. The latter can arise from an earlier start to second-line treatment associated with considerable side effects, but not with a prolongation of survival. Hence studies are urgently needed to investigate the patient-relevant benefit of PET or PET/CT in the diagnosis of ovarian cancers in direct comparison with conventional diagnostic techniques.

A ‘chemo-bath’ which delivers toxic cancer drugs to just one organ in the body has been used on patients in the UK for the first time, say doctors. Chemotherapy drugs kill rapidly growing cells such as cancers, but they also attack healthy parts of the body.
Doctors at Southampton General Hospital believe targeting just one organ can prevent side effects. They also say it means they can give higher doses without causing damage to the patient.
Chemotherapy drugs are normally injected into the veins of patients. However, the whole body, rather than just the tumour, is exposed. It results in side effects such as fatigue, feeling sick, hair loss and damage to fertility.
Two patients in the UK have now received chemotherapy focused on just their liver. Both had a rare eye cancer which had spread to the liver. The operation works by inflating balloons inside blood vessels on either side of the liver to isolate it from the rest of the body. The liver is then pumped full of chemotherapy drugs, which are filtered out before the liver is reconnected to the main blood supply.
It means only a tiny fraction of the chemotherapy dose ends up in the body.
Dr Brian Stedman, a consultant interventional radiologist, said: ‘To cut off an organ from the body for 60 minutes, soak it in a high dose of drug and then filter the blood almost completely clean before returning is truly groundbreaking.
‘Previously, the outlook for patients specifically suffering from cancer which has spread to the liver has been poor because standard chemotherapy’s effect is limited by the unwanted damage the drug causes to the rest of the body.’
The surgery took place in the past three months and both patients are said to be doing well and their tumours ‘all look smaller’, he said.
Dr Stedman told the BBC: ‘In 20 years’ time the idea of injecting a drug which poisons the whole body for a cancer in just one small area will seem bonkers.’
He suggested that any organ which could be easily separated from the blood supply, such as the kidney, pancreas and lungs, would be suitable for this kind of approach. However, he said the method was ‘in its infancy’ and he was ‘not sure this is the finished product or the end of the story’.
The technique is also being tested in the US and elsewhere in Europe. BBC

A new working party report from the Royal College of Physicians (RCP) says there should be a national system for recognising very sick patients whose condition is deteriorating and who need more intensive medical or nursing care. The working party also developed and piloted a National Early Warning Score for this purpose, which if implemented across the NHS, would result in a step-change upwards in patient safety.
Visit the NEWS pages of the RCP website to download the report and resources.
Speaking at a press conference to launch the National Early Warning Score, Professor Bryan Williams, chair of the working party, estimated that 6,000 lives could be saved by its use.*
The report, National early warning score (NEWS); standardising the assessment of acute-illness severity in the NHS, was produced by a multidisciplinary working group including doctors, nurses and managers. Clinical observation charts and e-learning materials were also produced by the NEWS educational programme, a collaborative project funded by the RCP, the Royal College of Nursing (RCN), the National Outreach Forum, and NHS Training for Innovation.
Each acute hospital bed has a chart that is used to record measurements such as the patient