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News Article | November 11, 2015
Site: motherboard.vice.com

Infectious disease researchers at Cedars-Sinai Hospital have uncovered something even more disquieting about the methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Far and away the most notorious (if not the most common) "superbug," MRSA isn't just resistant to its namesake penicillin-family antibiotics, it adapts itself to them, becoming stronger in the process. The Cedars-Sinai work, as described in the current Cell Host & Microbe, may ultimately offer new insights into what makes MRSA so powerful in the first place. MRSA causes 80,000 invasive infections and 11,000 related deaths per year in the United States. That's not a great record, and, despite ever-increasing hospital sanitation efforts and new and better antibiotics, the bug remains a dire threat. The origins of MRSA's myriad virulence factors—related to tissue adhesion, immune evasion, and host cell injury, generally— are not entirely clear, but together they pack a hell of a punch. A crew of pathogenic bacteria will move in and immediately get to work binding to host cells and tissue, stirring up every sort of inflammation, crushing the victim's immune system, building themselves a protective biofilm armor, and unleashing all sorts of toxins. It's a bad and often confounding scene. We know that MRSA packs a resistance gene, called mecA, that blocks the interfering action of beta-lactam antibiotics, such as the penicillin family. The beta-lactams inhibit production of certain enzymes the bacteria needs to develop cell walls, leaving them vulnerable. Without this enzyme neutralized, the pathogenic bacteria is free to go about its business of reproducing like crazy and scorched-earth tissue invasion. "MRSA is widely understood to be a pretty bad organism, and it is thought that it is somehow inherently more pathogenic than 'normal' S. aureus," David Underhill, the principle behind Cedars-Sinai's Underhill Laboratory and a co-senior author of the new study, told me. "While investigators have thought that this increased pathogenicity might be related exclusively to the presence of various toxins or other 'factors,' what our work suggests is that the very mechanism by which the bacterium becomes resistant to antibiotics makes it more inflammatory and damaging—in the presence of the type of antibiotic to which it becomes resistant." In a sense, what the Cedars-Sinai team found is that the bacteria are more than just neutralizing the beta-lactams' cell wall-busting enzyme, they're learning from it. As it turns out, the beta-lactam antibiotics don't quite neutralize all of the bacteria's cell wall-building enzymes. They miss one in particular, called PBP2A. The production of PBP2A is actually triggered by the presence of the beta-lactam antibiotics, so we can imagine it stepping in as a sort of replacement or surrogate. Like its neutralized forbearers, the enzyme enables the construction of cell walls by acting as a link or glue between different chains of proteins (a transpeptidase, properly), but these walls are different and more dangerous than other cell wells, according to the new study. In particular, the new cell walls induce increased inflammation in the host, which means more tissue damage and more virulence all around. So, the infection persists and in a worse form than had the infection been untreated. This poses a quandary to physicians. Most infections are treatable with beta-lactam antibiotics and they're thus administered as a first-line defense. If they don't work, then things escalate to different families of antibiotics known to be (relatively) effective against antibiotic-resistant bacteria. Can't we just start with the alternative antibiotics? No, not really, or not usually. The beta-lactam antibiotics are overall the most effective treatments going and they also happen to be pretty cheap, relative to the newer ones. Starting with the alternative would mean missing most infections at the outset, which isn't really acceptable either. Compounding things is that classifying a bacteria infection can take days, so most treatments are administered "blindly." It seems inevitable that, as things currently stand, some patients are going to wind up worse off and potentially with a poorer prognosis. Perhaps we can still be more careful. "I think the work can help us develop towards a more informed and effective choice of antibiotics," Underhill said. "We should be able to steer clear of antibiotics that we understand may have the potential to exacerbate already bad infections, and select ones that can be expected to be effective."


News Article | December 15, 2016
Site: www.businesswire.com

DETROIT--(BUSINESS WIRE)--The Detroit Medical Center (DMC) today announced that two teams of DMC physicians performed the first-ever MAKOplasty ™ Total Knee Replacement surgeries in the state of Michigan. The procedures took place simultaneously at both Harper University Hospital in Detroit and Huron Valley-Sinai Hospital in Commerce, Michigan on Wednesday, December 14. The breakthrough surgeries were completed using a robotic arm-assisted technology which ensures accurate alignment and placement of knee and hip implants for nearly perfect results. The DMC is the only hospital system in southeast Michigan to offer this technology. The DMC has used MAKOplasty technology since 2013 to perform other minimally invasive hip and knee procedures. In the past three years, the DMC has completed more than 1,300 MAKOplasty partial knee replacements and has grown to be the second largest MAKO program in the world. DMC’s Sinai-Grace Hospital, Harper University Hospital, and Huron Valley-Sinai Hospital all have the technology for a total of four MAKO robots within the DMC hospital system. "This is important for our growing population of orthopaedic patients because it can improve outcomes," said Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM, executive in chief for DMC Orthopaedics and Sports Medicine. "Advancements like these can lead to reduced hospital lengths of stay, reduced hospital readmission rates and other improvements. We have one of the most active robotic orthopaedic centers in the nation, with a large team of exceptionally trained surgeons which means we can offer our patients a full continuum of solutions for their knee and hip joint pain issues." The MAKO technology allows the surgeon to place and align the components with extreme precision, assuring a better outcome for the patient. When a single degree in any direction can make a difference on the performance of the new joint, being able to make alignments to within a millimeter is critical. The DMC can do that in real time in the operating room. This is the new standard for partial and total knee procedures. Russell Brynolf of Howell, Michigan was one of the first two patients to have the MAKO Total Knee Replacement. This was Brynolf’s second MAKO surgery as he was also the first patient to receive a partial knee replacement on his other knee three years ago. During that time, Brynolf was in so much knee pain that he was starting to have difficulty walking. Fifty-five years old at the time and a long-time soccer player, he sought the help of orthopaedic surgeon Dr. Roland Brandt at Huron Valley. "My first procedure went so well," said Brynolf. "The surgery center was like a five-star hotel and the staff was great. I was back up in a couple months and it was like a night and day difference. I had the surgery in December and in March I climbed a 960-foot waterfall in Jamaica." Brynolf is part of a growing segment of the population seeking solutions to knee and hip pain. According to data from the National Institutes for Health, approximately 700,000 total knee replacement procedures are performed annually in the United States. That number is expected to grow to nearly 3.5 million by the year 2030. Brynolf’s surgery was performed on December 14 at Huron Valley-Sinai Hospital by Dr. Roland Brandt. The other surgery was performed the same day by DMC’s Chief of Joint Replacement Hussein F. Darwiche, M.D., with assistance from Khaled Saleh, M.D. and Brian Little, M.D. at Harper University Hospital. Detroit Medical Center includes DMC Children’s Hospital of Michigan, DMC Detroit Receiving Hospital, DMC Harper University Hospital, DMC Heart Hospital, DMC Huron Valley-Sinai Hospital, DMC Hutzel Women’s Hospital, DMC Rehabilitation Institute of Michigan, and DMC Sinai-Grace Hospital. Detroit Medical Center is a leading regional healthcare system with a mission of excellence in clinical care, research and medical education.


News Article | November 15, 2016
Site: www.eurekalert.org

A study finds that smoking or being overweight makes it more difficult for patients with rheumatoid arthritis to achieve optimal control of inflammation and symptoms, despite standard of care treatment. American and Canadian researchers, who collected data on more than 1,100 patients at multiple sites, presented their findings at the American College of Rheumatology/Association of Rheumatology Health Professionals annual meeting on November 15 in Washington, DC. "Early, aggressive treatment to achieve remission is the primary goal of therapy and can be best achieved early on when treating patients with newly diagnosed rheumatoid arthritis, as early disease control is associated with improved long-term outcomes," said Vivian Bykerk, MD, senior investigator and director of the Inflammatory Arthritis Center of Excellence at Hospital for Special Surgery. "We have previously shown that individuals with excess weight are less likely to achieve sustained remission in the first three years after diagnosis. Here we explore the impact of smoking and being overweight or obese on the ability to achieve good control of symptoms and inflammation in men and women with rheumatoid arthritis." Data were collected at 19 sites across Canada as part of the CATCH (Canadian Early Arthritis Cohort) Study. The multicenter study included rheumatoid arthritis patients diagnosed within 12 months of symptom onset. Researchers looked at the patient's disease activity score, known as the DAS, when they entered the study and at follow-up visits. The DAS is based on the number of swollen and tender joints, a blood test that reflects inflammation, and the patient's own description of their arthritis symptoms over the prior week. After the initial enrollment, patients were seen by their rheumatologist as part of their usual care for follow up every three months in the first year, every six months in the second year, and annually thereafter. Data about their arthritis were collected at each visit. The researchers analyzed how gender, excess weight and smoking (current/former/never) affected symptoms when patients entered the study and over time. The study included 1,109 patients with a mean age of 54 at study onset. Almost all of them were being treated with methotrexate and/or another conventional oral medication when they enrolled. Most of the participants (72%) were female. Among the women, 31% were overweight, 32% were obese, and 15% currently smoked. Among the males, 44% were overweight, 35% were obese and 22% currently smoked. Sex, excess weight and smoking were not significantly associated with symptom severity early on, when patients entered the study. However, all three factors influenced how much symptoms improved over time. The average rate of improvement in the disease activity score was lower in women compared to men. Less symptom improvement was also seen in patients who were overweight or obese compared with those of a healthy weight. Current smokers also saw less symptom relief compared to nonsmokers over time. Former smokers, however, did not do worse than those who had never smoked. The most dramatic differences in symptoms were seen in patients who were overweight or obese and smoked. These patients had considerably worse outcomes over time compared to nonsmoking patients with a healthy weight. "These results contribute to growing evidence of how lifestyle impacts how well patients may respond to treatment and the potential value of referring them to proven community-based smoking cessation and weight management programs," Dr. Bykerk concluded. Authors: Susan J. Bartlett1,2, Orit Schieir3, Kathleen Andersen4, Gilles Boire5, Boulos Haraoui6, Carol Hitchon7, Edward Keystone8, Janet E. Pope9, J Carter Thorne10, Diane Tin11, Vivian P. Bykerk12 and Canadian Early Arthritis Cohort (CATCH) Investigators, 1Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, 2Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 3University of Toronto, Toronto, ON, Canada, 4Rheumatology, Hospital for Special Surgery, New York, NY, 5Rheumatology Division, CHUS - Sherbrooke University, Sherbrooke, QC, Canada, 61551, Ontario Street East, Institut de Recherche en Rhumatologie de Montréal (IRRM), Montreal, QC, Canada, 7University of Manitoba, Winnipeg, MB, Canada, 8Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada, 9University of Western Ontario, St Joseph's Health Care, London, ON, Canada, 10Southlake Regional Health Centre, Newmarket, ON, Canada, 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 12Divison of Rheumatology, Hospital for Special Surgery, New York, NY Hospital for Special Surgery (HSS) is the world's largest academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www. .


News Article | March 1, 2017
Site: www.marketwired.com

Quick reference for busy clinicians is one of three new oncology and cancer research titles CAMBRIDGE, MA--(Marketwired - March 01, 2017) - Elsevier, a world-leading provider of scientific, technical and medical information products and services, today announced the publication of Handbook of Supportive and Palliative Radiation Oncology by Monica Krishnan, Margarita Racsa and Hsiang-Hsuan Michael Yu. A practical tool and rapid reference for radiation oncology practitioners in direct patient care, the book covers the most recent advances in translational palliative care research. It is organized in a succinct fashion to discuss major symptom burdens, suggested assessment and various management options. Elsevier also announced publication of two additional oncology and cancer research books. Handbook of Supportive and Palliative Radiation Oncology begins by describing general approaches in palliative radiation oncology, followed by a section focused on common symptoms in palliative care and their management. The next section of the book is devoted to site and disease-specific evaluation, intervention and management. This handbook offers general guidelines and management recommendations for common clinical vignettes encountered by palliative radiation oncology practitioners and supported by palliative radiation oncology research, citing concise references to support treatment recommendations. Learn more about the general approach to palliative radiation oncology in this sample chapter. Dr. Monica Krishnan is an attending physician at the Dana-Farber/Brigham and Women's Cancer Centers at South Shore and Milford, Massachusetts. She has developed a palliative radiation clinic at these community cancer centers, working in tandem with the Supportive and Palliative Radiation Oncology (SPRO) program at the main campus in Boston. Dr. Krishnan has a strong interest in palliative radiation and has done extensive research assessing prognostication and its role in treatment decision making. Dr. Margarita Racsa is a radiation oncologist who recently completed a Palliative Medicine Fellowship at Memorial Sloan Kettering in New York. She presently is a Fellow with the Supportive and Palliative Radiation Oncology (SPRO) Service at the Dana-Farber/Brigham and Women's Cancer Center in Boston. Dr. Racsa has a strong interest in palliative care education including working on an initiative to develop a core curriculum in palliative care for radiation oncology residency programs. Dr. Hsiang-Hsuan Michael Yu is a radiation oncologist at Sinai Hospital in Baltimore, MD. Prior to Sinai, he was the service chief of Central Nervous System Radiation Oncology with a focus in management of brain metastasis at H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Dr. Yu is board certified in radiation oncology and hospice and palliative medicine. He has gained interest in palliative radiation oncology from clinical practice and is playing an active role to initiate a comprehensive palliative radiation oncology program. The three new oncology and cancer research titles are: In order to meet content needs in oncology and cancer research, Elsevier uses proprietary tools to identify the gaps in coverage of the topics. Editorial teams strategically fill those gaps with content written by key influencers in the field, giving students, faculty and researchers the content they need to answer challenging questions and improve outcomes. These new books, which will educate the next generation of oncologists and cancer researchers, and provide critical foundational content for information professionals, are key examples of how Elsevier is enabling science to drive innovation. Note for Editors E-book review copies of the new books are available to credentialed journalists upon request. Contact Jelena Baras at sciencereviewcopies@elsevier.com. About Elsevier Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions -- among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey -- and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com


Costa C.R.,Sinai Hospital
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

The diagnosis of periprosthetic hip infections is often challenging. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level blood laboratory tests are commonly used to aid in the diagnosis. We studied the sensitivity, specificity, and false-negative rates of ESR and CRP level in a prospective group of patients who underwent revision total hip arthroplasty between 2000 and 2008. Seventy-seven patients with periprosthetic hip infections and ESR and CRP data were identified. Chi-square analysis was performed to determine the significance of false-negatives, compared with sex, body mass index, primary diagnosis, infection type, and immunity status. ESR had 89% sensitivity and 69% specificity. CRP level had 93% sensitivity and 40% specificity. The false-negative rate was 10.8% for ESR and 7% for CRP level. The false-negative rate for ESR and CRP level combined (with either result positive) was 3%. All false-negatives in the combined group were immunocompromised. Chi-square analysis did not find a significant correlation between false-negatives and any other variables. ESR and CRP level are useful in the diagnosis of periprosthetic hip infections. Ordering these tests concurrently reduces the chance of false-negative results.


Herrera-Garcia G.,Sinai Hospital | Contag S.,Sinai Hospital
Current hypertension reports | Year: 2014

Hypertensive disease of pregnancy (HDP) has been associated with elevated lifetime cardiovascular risk, including stroke, myocardial disease, coronary artery disease, and peripheral arterial disease. These two entities share common risk factors such as obesity, insulin resistance, diabetes, and hypertension. This article will evaluate the current literature on the maternal and fetal cardiovascular risks posed by HDP. The landmark study by Barker et al. demonstrated increased cardiovascular risk in growth-restricted infants, which may also be associated with HDP. Research has demonstrated the effects that HDP may have on the vascular and nephron development in offspring, particularly with respect to endothelial and inflammatory markers. In order to control for confounding variables and better understand the relationship between HDP and lifetime cardiovascular risk, future research will require following blood pressure and metabolic profiles of the parturients and their offspring.


Katlic M.R.,Sinai Hospital | Coleman J.,Sinai Hospital
Annals of Surgery | Year: 2014

Human faculties-even those of surgeons-deteriorate with age, but there is great variability. Decisions about competency, therefore, should be based on functional age rather than chronologic age. This argues against a mandatory retirement age and argues for an objective evaluation of functional age. Such an assessment would balance the dignity of a committed practitioner and his or her value to society with patient safety and liability risk. One way to do this is presented, namely The Aging Surgeon Program, a comprehensive, multidisciplinary, objective, and confidential evaluation. Both the surgeon and society deserve no less. Copyright © 2014 by Lippincott Williams & Wilkins.


News Article | October 29, 2016
Site: www.prweb.com

The Center for Vein Restoration (CVR), the nation’s largest, physician-led, vein treatment medical organization, is proud to announce expansion to Rosedale, MD. CVR's newest location has just begun seeing patients and is located at 9110 Philadelphia Road, Suite 306, Rosedale, MD 21237. Dr. Dov Frankel is proud to now serve on the team at the Center for Vein Restoration, where physicians have rededicated their careers to bringing relief to patients coping with venous disease. "I have always been fascinated by the human anatomy. As an emergency medicine physician, I take pride in the numerous medical procedures I perform on a daily basis. I was trained in the era of Ultrasound and have always had a passion for US guided procedures." Dr. Frankel continues, "Treating venous insufficiency combines my talents in medicine to best care for my patients in a safe and comfortable environment." Dr. Frankel’s dedication to providing state-of-the-art treatments comes at an important time. He states, "Venous disease is very prevalent in the US affecting nearly 40% of all individuals. The disease process ranges from mild discomfort with aesthetic un-pleasantries to significant morbidity." He continues, "The ability to treat patients with minimally invasive procedures using local anesthetics and giving patients significant relief and cure if very interesting to me." A native of Montreal, Canada, Dr. Dov Frankel obtained his Master of Science from McGill University in 1999, then went on to receive his MD at Ben Gurion University. Dr. Frankel completed his Emergency Medicine Residency at UAMS – Arkansas and during his last year, served as Chief Resident of the Emergency Medicine Department in 2005. He then joined Sinai Hospital in Baltimore, MD as an attending Emergency Physician and was appointed Associate Chief of the Emergency Department from 2007-2014. Dr. Frankel is a published author of scientific literature and has received multiple awards including "Best Poster Presentation Award" from McGill University and two-time winner of Baltimore Magazine's Top Doctors, to name a few. Venous insufficiency, the cause of varicose veins and spider veins, indiscriminately affects between 30–40 million Americans. Numerous factors including age, weight, prolonged sitting or standing, genetics or a history of DVT (blood clots) can increase the risk of developing this all-­to-­common and often under-diagnosed disorder. Treatment options range from lifestyle changes like exercising or taking regular breaks from prolonged sitting or standing to an array of minimally-­invasive, outpatient procedures that close problem veins, redirecting blood flow to healthier ones. Having performed its first procedure in 2007 under President and CEO Dr. Sanjiv Lakhanpal, Center for Vein Restoration (CVR) has since become a nationally recognized leader in the treatment of varicose and spider veins. Dedicated to relieving leg pain, treating the vascular cause of severe leg wounds, and eliminating unsightly veins, CVR’s minimally invasive procedures allow patients to look better, feel better, and live better. With 60 locations and counting, they have assembled the most qualified and experienced team of physicians, researchers, and staff to serve patients across Alabama, Connecticut, Indiana, Maryland, Michigan, New Jersey, New York, Pennsylvania, Virginia, and Washington, DC. For more information, visit http://www.centerforvein.com. You may also contact Nicole McMillan at nicole(dot)mcmillan(at)centerforvein(dot)com or 240-965-3277.


As 21-Year-Old Model Gigi Hadid Reveals She is Dealing with Hashimoto's Disease Over the Past Two Years, Noted Beverly Hills Physician Dr. Larian Offers Important - and Life-Saving Observations BEVERLY HILLS, CA / ACCESSWIRE / December 14, 2016 / When 21-year-old Victoria's Secret model Gigi Hadid opened up about her battle with Hashimoto's Disease over the course of the past two years, the public instantly wanted to know more about her condition. More common among women than men, the disease is an immune system disorder that affects the thyroid, which controls metabolism, weight, body temperature, heart rate, and the menstrual cycle. Symptoms include weight gain, fatigue, puffiness of the face, joint and muscle pain, depression, slow heart rate and increased risk of developing other autoimmune disorders, including vitiligo, rheumatoid arthritis, Addison disease, type 1 diabetes, multiple sclerosis, and pernicious anemia. A patient with Hashimoto's can also have irregular or heavy menstrual periods and difficulty getting pregnant. In light of Hadid's announcement, Beverly Hills surgeon Dr. Babak Larian offered more information on Hashimoto's Disease and the importance of testing for the disease should symptoms occur. "It was brave of Gigi Hadid to disclose her battle with Hashimoto's Disease, and her announcement can help many of the approximately 2-5 percent of the US population that is also suffering from the disease. Hashimoto's Disease can be attributed to genetic and environmental factors. Radiation exposure or too much iodine can be contributing factors, although genetics are the primary source. The disease can cause a decrease in thyroid function (hypothyroid) and increase the risk of thyroid cancer. If anyone thinks they may have Hashimoto's, it is important to conduct blood tests for thyroid function and undergo ultrasound tests every two years to stay on top of the disease," said Dr. Larian. Babak Larian, M.D. (http://www.larianmd.com/thyroid/) is a highly experienced head and neck surgeon. A leader in his field, Dr. Larian serves as the Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles and was named one of U.S. NEWS & WORLD REPORT's Top Doctors. In addition to being involved with designing equipment for minimally invasive thyroid surgery, Dr. Larian trains other surgeons, presents at national conferences, and regularly performs clinical research. As 21-Year-Old Model Gigi Hadid Reveals She is Dealing with Hashimoto's Disease Over the Past Two Years, Noted Beverly Hills Physician Dr. Larian Offers Important - and Life-Saving Observations BEVERLY HILLS, CA / ACCESSWIRE / December 14, 2016 / When 21-year-old Victoria's Secret model Gigi Hadid opened up about her battle with Hashimoto's Disease over the course of the past two years, the public instantly wanted to know more about her condition. More common among women than men, the disease is an immune system disorder that affects the thyroid, which controls metabolism, weight, body temperature, heart rate, and the menstrual cycle. Symptoms include weight gain, fatigue, puffiness of the face, joint and muscle pain, depression, slow heart rate and increased risk of developing other autoimmune disorders, including vitiligo, rheumatoid arthritis, Addison disease, type 1 diabetes, multiple sclerosis, and pernicious anemia. A patient with Hashimoto's can also have irregular or heavy menstrual periods and difficulty getting pregnant. In light of Hadid's announcement, Beverly Hills surgeon Dr. Babak Larian offered more information on Hashimoto's Disease and the importance of testing for the disease should symptoms occur. "It was brave of Gigi Hadid to disclose her battle with Hashimoto's Disease, and her announcement can help many of the approximately 2-5 percent of the US population that is also suffering from the disease. Hashimoto's Disease can be attributed to genetic and environmental factors. Radiation exposure or too much iodine can be contributing factors, although genetics are the primary source. The disease can cause a decrease in thyroid function (hypothyroid) and increase the risk of thyroid cancer. If anyone thinks they may have Hashimoto's, it is important to conduct blood tests for thyroid function and undergo ultrasound tests every two years to stay on top of the disease," said Dr. Larian. Babak Larian, M.D. (http://www.larianmd.com/thyroid/) is a highly experienced head and neck surgeon. A leader in his field, Dr. Larian serves as the Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles and was named one of U.S. NEWS & WORLD REPORT's Top Doctors. In addition to being involved with designing equipment for minimally invasive thyroid surgery, Dr. Larian trains other surgeons, presents at national conferences, and regularly performs clinical research.


News Article | December 1, 2016
Site: www.eurekalert.org

A veteran with a rare type of cancer may have developed the condition after being exposed to Agent Orange during the Vietnam War, reveal doctors writing in the journal BMJ Case Reports. The 69-year-old patient was admitted to hospital with a 1-year history of a painful and enlarging mass in his right thigh. Ultrasound and CT scans identified the mass, and a subsequent biopsy confirmed a rare malignant soft issue cancer, known as pleomorphic liposarcoma. The cancer was removed during surgery and this was followed by a course of radiotherapy. The patient asked if the tumour was related to his exposure to Agent Orange while serving in the Vietnam War. From 1963 to 1965, he was in frequent contact with forested areas that were sprayed with Agent Orange, a toxic chemical aimed at depriving the Viet Cong of crops and vegetation cover. 'Operation Ranch Hand' led to the deposition via helicopter, boats and trucks of 72 million litres of chemicals across the forested and rural areas of Vietnam for this sole purpose. The bulk of these chemicals was Agent Orange which included TCDD -- a toxic chemical that has been recognised to have the potential to cause cancer. Doctors from Sinai Hospital in Baltimore, Maryland, USA, say the link between the veteran's cancer and a wartime toxin exposure is possible. The patient's cancer, pleomorphic liposarcoma, is the rarest type of liposarcoma cancer and has a high rate of local recurrence and ability to spread to other parts of the body. "There has been no well-established precipitating factor for liposarcomas," they explain. "However, clinicians should have a high degree of suspicion for persistent and evolving soft tissue masses, especially in patients with a previous military background. This should prompt the search for a possible toxin exposure." They continue: "The patient was educated about his diagnosis and was counselled about the unfortunate side effects with which Agent Orange has been associated. He continues to be monitored for disease recurrence and will continue to do so for years." BMJ Case Reports is an award winning journal that delivers a focused, peer-reviewed, valuable collection of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. This is the largest single collection of case reports online with more than 11,000 articles from over 70 countries. For more information, visit: http://www.

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