Metal-on-metal hip implant risks 'unique'

Metal-on-metal hip implant risks 'unique' -  FDA gives recommendations on how often implants patients should receive clinical exams

Metal-on-metal hip implants can cause soft-tissue damage that may lead to pain and the need for more surgeries, a U.S. regulator said in updating information for patients and surgeons.

The U.S. Food and Drug Administration recommended that patients be informed of the benefits and risks of metal-on-metal hip implants, including that the implant may need to be replaced.

When the metal ball and metal cup in the implants can rub against each during walking or running, metal can be released from the parts that may cause damage to the bone and soft tissue surrounding the implant and joint, the FDA said.

"Metal-on-metal hip implants have unique risks in addition to the general risks of all hip implants," the FDA said on its website.

Authorities in Canada, the U.S. and the UK have warned full metal-on-metal hip implants may be more likely to fail and can cause tissue damage around the joint compared with the traditional metal-and-plastic type of implants.

On Thursday, the FDA issued new recommendations on how often all implants patients should receive clinical exams and when to consider soft tissue imaging and metal ion tests for those showing symptoms.

Reports of adverse events include pain, change in position of a component of the implant, allergy and dislocation.

Last year, data from the U.K. and other countries suggested metal-on-metal implants are are more likely to deteriorate, exposing patients to higher levels of cobalt, chromium and other metals. ( cbc.ca )

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Brain of neglected child is much smaller than that of a normal three-year-old

Horrifying scans that show the real impact of love: Brain of neglected child is much smaller than that of a normal three-year-old - According to neurologists the sizeable difference between these two brains has one primary cause - the way were treated by their mothers - Both of these images are brain scans of a two three-year-old children, Brain on the left is considerably larger, has fewer spots and less dark areas, compared to the one on the right

You comfort them over a skinned knee in the playground, and coax them to sleep with a soothing lullaby.

But being a nurturing mother is not just about emotional care - it pays dividends by determining the size of your child's brain, scientists say.

Both of these images are brain scans of a two three-year-old children, but the brain on the left is considerably larger, has fewer spots and less dark areas, compared to the one on the right. 

According to neurologists this sizeable difference has one primary cause - the way each child was treated by their mothers. 

Shocking: According to neurologists the sizeable difference between these two brains has one primary cause - the way were treated by their mothers

The child with the larger and more fully developed brain was looked after by its mother - she was constantly responsive to her baby, reported The Sunday Telegraph. 

But the child with the shrunken brain was the victim of severe neglect and abuse.

According to research reported by the newspaper, the brain on the right worryingly lacks some of the most fundamental areas present in the image on the left. 

 

Crucial: A mother's love is fundamental to how a child's brain develops

The consequences of these deficits are pronounced - the child on the left with the larger brain will be more intelligent and more likely to develop the social ability to empathise with others.

But in contrast, the child with the shrunken brain will be more likely to become addicted to drugs and involved in violent crimes, much more likely to be unemployed and to be dependent on state benefits.

The child is also more likely to develop mental and other serious health problems.

Professor Allan Schore, of UCLA, told The Sunday Telegraph that if a baby is not treated properly in the first two years of life, it can have a fundamental impact on development.

He pointed out that the genes for several aspects of brain function, including intelligence, cannot function.

And sadly there is a chance they may never develop and come into existence. 

Life decisions: The brain on the right is more likely to become addicted to drugs and involved in violent crime than the child on the left

These has concerning implications for neglected children that are taken into care past the age of two. 

It also seems that the more severe the mother's neglect, the more pronounced the damage can be.

The images also have worrying consequences for the childhood neglect cycle - often parents who, because their parents neglected them, do not have fully developed brains, neglect their own children in a similar way. 

But research in the U.S. has shown the cycle can be successfully broken if early intervention is staged and families are supported. 

The study correlates with research released earlier this year that found that children who are given love and affection from their mothers early in life are smarter with a better ability to learn.

The study by child psychiatrists and neuroscientists at Washington University School of Medicine in St. Louis, found school-aged children whose mothers nurtured them early in life have brains with a larger hippocampus, a key structure important to learning, memory and response to stress.

The research was the first to show that changes in this critical region of children’s brain anatomy are linked to a mother’s nurturing, Neurosciencenews.com reports.

The research is published online in the Proceedings of the National Academy of Sciences Early Edition.

Lead author Joan L. Luby, MD, professor of child psychiatry, said the study reinforces how important nurturing parents are to a child's development. ( dailymail.co.uk )

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Is a New Heat Sensing Bra the Breast Medicine?

Is a New Heat Sensing Bra the Breast Medicine? — I’m usually satisfied when my bra gives me a little extra lift. Now there’s one that not only lifts, it separates — the healthy breast tissue from the unhealthy breast tissue, that is.

The makers of the First Warning Systems bra claim it can detect cancer in its earliest stages by continually monitoring the breasts for temperature changes associated with growing tumors. When a series of sensors embedded in the cups detect abnormal heat patterns, they send a signal to alert doctors to the possible presence of cancer cells.

Talk about your wonder bra!

In three separate clinical trials involving 650 women, the makers said the bra was able to identify the presence of tumors six years before traditional breast imaging did. It also scored a 92 percent level of accuracy in correctly classifying breast tissue as normal, benign, suspected for abnormalities, or probable for abnormalities. Routine mammograms have an accuracy rate of only 70 percent.

If this works as advertised, this is very exciting news for women who prefer to avoid the radiation associated with mammography, especially women with lumpy breasts or a family history of breast cancer. These women typically submit to mammography screenings more often than average and many are troubled by the health risks. And, since mammography isn’t very good at picking up breast cancer in women under forty, this could be a better option for them too.

That is, if it works as advertised.

Unfortunately, the word from Dr. Deanna J. Attai, a spokeswoman for the American Society of Breast Surgeons, leaves my hopes sagging. So to speak, of course.

“The technology is promising but I’m a long way off from recommending it,” she said. “We need a lot more comparison to other screening technologies, and we need follow women over a much longer period of time to determine if this actually a reliable test.”

Attai said she has more questions than answers about thermography, the type of imaging related to the technology the bra uses. In a perfect world, the scan for breast hot spots would correlate with the results of mammogram, MRI and ultrasound tests. This is often not the case.

Attai said she has seen thermograms come back normal or showing marginal changes to breast tissue when a woman was then diagnosed with cancer through other means. She’s seen a lot of false positives too, and she worries this can lead to a lot of unnecessary stress and expense.

“Even if we get an abnormal reading from thermal scanning, what do we do? If it’s not giving you a clear enough picture and you’re going to do all the other follow up tests anyway, I’m not sure I see the value.”

Matt Benardis, First Warning’s chief of operations, countered that the bra is a vast improvement over standard thermography because it takes repeated snapshots of heat changes over time rather than in a single instance. The idea is to start taking scans at around the age of 18 and then track differences in breast tissue over time.

“It’s a dynamic look at what is taking place in the breast tissue. We can identify the disruptions in the breast tissue in a non-invasive way years before tumor presentation,” he said, though he was quick to point out that it is an early detection system rather than a diagnostic tool.

If a scan turns something up, First Warning recommends the doctor take it from there with follow-up tests and standard diagnostic protocols.

Which is kind of Attia’s point.

So, as much as I’d love some DD diagnostics to take the place of my mammogram pilgrimages, no study has found thermography to be an effective screening tool for finding breast cancer early. And Attia warns that women shouldn’t use the bra as a substitute for any test a doctor recommends.

The bra will go on sale in Europe sometime in 2013 for around $200. The company says women will purchase the bra from their doctors, though as of now, the cost is not covered by insurance. On the positive side, though, it can be tossed in the wash after each use. ( Good Morning America )

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Face Transplants: A Surgical Success Story

Face Transplants: A Surgical Success Story - Face-transplant technology has come a long way in seven years.

Richard Lee Norris, a Virginia man who was severely disfigured after a gun accident in 1997, has made a notable recovery after undergoing the world's fullest face transplant in March.

"People used to stare at me because of my disfigurement," Norris, 37, said in a prepared statement. "Now they can stare at me in amazement and in the transformation I have taken."

Norris' 36-hour transplant of a donor face was one of 23 done worldwide since 2005, and the most recent of six done in the United States, including those of Charla Nash and Dallas Weins.

"If you would have told me 20 years ago, would this be possible? I would say absolutely not," said Norris' surgeon, Dr. Eduardo Rodriguez of the University of Maryland Medical Center. "It's hard to imagine it's the same person, isn't it?"

The goal for Norris' transplant, Rodriguez said, was to restore both form and function.

 

From left, Charla Nash, Dallas Weins and Richard Lee Norris are pictured post-face transplant.

"I strongly believe that it is the most aesthetically acceptable result thus far," he said. "I am only hopeful that the functional result will be as good as the aesthetic result."

Compared to the first face transplant case in 2005, which included just the soft tissues of the nose, lips and chin, Rodriguez and his team transplanted the entire face from scalp to neck, complete with teeth, bones, muscles, nerves and skin.

They removed the entire face in one piece and used 3-D modeling software to ensure a perfect fit. Norris was also the first face transplant patient to receive a special anti-rejection drug before his treatment, in order to limit early rejection of his new face.

"Face transplantation is one of the biggest innovative breakthroughs in last decade," said Dr. Maria Siemionow, a plastic surgeon at the Cleveland Clinic who led the country's first near-total face transplant in 2008.

"We are moving forward," Siemionow added. But "it takes time."

Face transplant recipients rely on a cocktail of drugs to prevent their immune systems from attacking the new face, drugs that come with a hefty price tag and serious side effects. Early research suggests it might be possible someday to engineer new faces using the patient's own stem cells seeded on a donor framework, but that's still decades away.

In Norris' case, the transplanted jaw bones contained donor stem cells to help coax his body into accepting the new face. Such an approach was based on a decade of animal research at the University of Maryland transplant team's laboratory.

But face transplant experts have learned tough lessons after some heart-breaking disappointments. One Chinese partial face transplant patient died of unknown causes in 2008. His transplant surgeons reported in Agence-France Press that he had stopped taking his anti-rejection drugs in favor of herbal medications.

"Patient selection is very important," said Dr. Joseph Losee, director of the reconstructive transplantation program at the University of Pittsburgh Medical Center, explaining that the results can be disastrous if patients don't remain committed to their follow-up treatment. "Not everybody should get reconstructive transplant surgery."

One critical factor in Norris' transplant success was his commitment as a patient, surgeon Rodriguez said.

"There's only so much we can do with our hands. The rest is up to the patient," he said, adding that Norris was selected by an expert committee that included psychiatrists, psychologists and social workers. "He has done everything exactly as we've asked him to do."

Rodriguez and other transplant surgeons hope to one day extend the use of face transplants to replace numerous reconstructive surgeries in children with disfiguring facial birthmarks, burn victims and wounded warriors.

"I believe that face transplants will eventually become more common, as there are no alternatives that authentically restore our human facial features," said Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's Hospital in Boston who performed the country's first full-face transplant in 2011.

"Provided that the patients continue to do well, we will likely expand our transplant program to include patients with less severe deformities."

In order to perform more face transplants, however, more people would have to sign up to be donors.

"I imagine that it would be difficult to donate your loved one's face," Rodriguez said, adding that he was amazed at the positive reaction he has encountered so far from donor families.

As a final touching gesture, Norris' donor left the operating room with a silicon replica of his face to cover the defect left after the removal of the face in case the family opted for an open-casket funeral, Rodriguez said.

"We were committed to restoring the integrity of the donor as much as possible," he said. ( abcnews.com )

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