Shout-out: Firework Safety Review

Fireworks are beautiful - but care and safety are needed to avoid burns and injuries. Dr. Ramona Bates, from the suture for a living blog, has written an nice review piece about how to safely deal with fireworks. The link is below. It's especially timely with the July 4 holiday fast approaching. Please read it, and explain it to your kids & teenagers. Nobody wants burns or eye injuries, after all!

Firework Safety Review

Have a wonderful 4th!

photo credit: digital-photography-school.com. A photo of fireworks over Vancouver harbor.

OT: airport scanners in the news

When traveling, I've often wondered why the TSA agents don't wear the little dosimetry badges that all medical and dental personnel who work around X-rays wear on their lapels. It's a standard safety precaution in the industry, another method of ensuring that medical personnel aren't inadvertently getting exposed to too much radiation at work.

Well, here's an article from TIME magazine on this very topic. It turns out that a few TSA agents in Boston have developed various cancers, and they're wondering if it's linked to their X-ray screening equipment. If they had been wearing dosimetry badges, they would have known if X-ray leakage was a problem!

The TIME magazine report also implies that the X-ray based machines may not have been as rigorously tested for safety as some might like...

FDA update on breast implants - 2011

When the FDA re-approved silicone breast implants for general use, back in November of 2006, one of the conditions was that the two major manufacturers and the FDA would co-operate to do some ongoing follow-up studies about implant safety and effectiveness. Now, approximately 5 years later, the FDA has released an update, discussing the first installment of this data.

In a nutshell: it confirms what we knew 5 years ago. Implants, when used correctly, are safe devices...but they're not perfect.

The report says the same things we tell patients at their consultations for breast augmentation...

1) Implants don't last forever. They get old, become brittle, and eventually need to be replaced. This means more surgery, at some point in the future.

2) They can get in the way of mammograms. Other imaging techniques, like MRI and ultrasound, are very helpful in examining the implant and hard-to-see breast tissue.

3) The implants can get hard, due to capsular contracture, in a minority of patients. This is still the most frustrating, unsolved problem of breast implant surgery, long-term.

And these issues are also true for saline filled implants, as well.

Good news: the FDA study continued to find no linkage at all between silicone gel implants and breast cancer, or between silicone gel breast implants and auto-immune diseases, such as lupus, scleroderma or rheumatoid arthritis.

The FDA website has much more details. Their consumer page is here.

France bans mesotherapy

Here's an interesting development in the mesotherapy (melting fat by injection) story: as of early April 2011, the French Ministry of Health has outlawed all mesotherapy for the purpose of dissolving subcutaneous fat. Whether you call it "Lipodissolve", "mesotherapy", or "injection lipolysis"...it's no longer permitted there. The Ministry of Health views it to be a serious health risk. As you may recall, France was the birthplace of mesotherapy, about 50 years ago - so they probably know more than anyone about the technique.

It will be interesting to see what the reaction will be here. Lipodissolve methods have had a checkered past here in the USA, although there is starting to be some good science on compounds like ATX-101, which we've discussed in an earlier blog (link here).

Voici la texte originale...

Spray-on skin grafts?

Here's a cool new idea: spray-on skin grafts.

Using the ReCell kit, a small skin biopsy is processed, turning the sliver of skin into a suspension of cells. This takes about 30 minutes. The resulting liquid is then sprayed onto the area of second-degree burns. And here's a bonus: you can cover a much bigger area with this method, compared to the size of the initial skin sample. For example, the developer, Dr. Fiona Wood from Australia, says she has been able to use a piece of skin the size of a postage stamp to cover a burn across the whole of child’s chest. While this technology has existed for a few years, it always required lab processing of the tissue: this method uses a compact, go-anywhere kit.

There are other benefits, too. The researchers suggest spray-on skin results in less scarring than normal grafting, even when a graft has not been meshed. And the need to remove only a small piece of skin means it is easier to match the colour of the grafted tissue to the place where it is going. Scar revisions and treatment of pigmentation problems have also been performed with this method.

Naturally, the U.S. military is very interested in this. The Armed Forces Institute of Regenerative Medicine (AFIRM) is co-sponsoring a trial of the technology, supporting it with $2 million as the lead element of a new five-year regenerative medicine program designed to better help injured soldiers.

Pretty cool stuff - but sadly, it's not FDA approved yet.

New FDA rules for sunscreens

This week, the FDA announced a series of changes that will affect how sunscreens are labelled. This is a good thing for consumers: the manufacturers will have to be very clear about whether the product products against UVA rays, or the more typical UVB. Misleading terms like "sunblock" and "waterproof" are going to be eliminated. Just so you know: there is no sunscreen yet invented that is totally waterproof, or is a 100% sunblock. These are BS marketing terms.

Under the new labeling system, which takes effect in 2012, the key feature to look for on the label will be the term "broad spectrum". If you see this, then you are getting both UVA and UVB protection, which is what you want. Here's an example of how the new labels might look - there's much more useful information.



Here's more details, directly from the FDA website....

Q. What are the main points of the new FDA sunscreen rule?

A. The new final rule includes the following requirements:

Broad Spectrum designation. Sunscreens that pass FDA's broad spectrum test procedure, which measures a product's UVA protection relative to its UVB protection, may be labeled as "Broad Spectrum SPF [value]" on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet.

Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn.

"Waterproof, "sweatproof" or "sunblock" claims. Manufacturers cannot label sunscreens as "waterproof" or "sweatproof," or identify their products as "sunblocks," because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example-- "instant protection") without submitting data to support these claims and obtaining FDA approval.
Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating.

Drug Facts. All sunscreens must include standard "Drug Facts" information on the back and/or side of the container.

Sunscreen lotions will also no longer be able to advertise that they carry an SPF, or sun protection factor, of greater than 50.


Photo credits: pharmacymix.com, myhealthnewsdaily.com

Novel melanoma drug 'dramatic'

Source: Dermatology Times E-News

A new study reveals dramatic results for an experimental drug designed to attack a melanoma tumor’s genetic trigger in patients with advanced disease.

About half of melanoma patients’ tumors carry a mutation of the BRAF gene, which causes skin cells to reproduce out of control. The experimental drug, called PLX4032 or vemurafenib, reverses the effects of that mutation. The new study, led by Paul Chapman, M.D., of New York’s Memorial Sloan-Kettering Cancer Center, involved 675 patients with advanced, inoperable melanoma with the BRAF gene mutation. The patients were treated either with dacarbazine, the standard chemotherapy drug, or with PLX4032.

Investigators report that after three months, PLX4032 was so obviously effective that the study was stopped so that dacarbazine patients could switch to the new drug. Study results show that PLX4032 shrank tumors significantly in nearly half the patients, reduced by two-thirds the risk that the disease would progress, and decreased the chance of fatality by 63 percent.

Side effects included skin rashes and joint pain, but researchers report that the effects tended to be far less severe than those caused by standard chemotherapy.

“This is really a huge step toward personalized care in melanoma. This is the first successful melanoma treatment tailored to patients who carry a specific gene mutation in their tumor”, said Dr. Chapman.

OT: Would you give a 7 year old this?

More bizarre parenting, this time from the UK. Plastic-surgery obsessed mom gives daughter a voucher for breast augmentation...but she's only SEVEN.

Here's the story, from the Daily Mail:

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She made the headlines last year when she confessed to teaching her then six-year-old daughter Poppy to pole dance. And now Sarah Burge is back in the spotlight again - for all the wrong reasons. The 50-year-old mother - a self-confessed plastic surgery addict known as The Human Barbie - has boasted that she gave a £6,000 breast enlargement voucher to her daughter for her seventh birthday. Miss Burge, who has spent more than £500,000 on her own surgical enhancements and wants to make her daughter into a glamour model, said Poppy 'squealed with delight' when she was given the voucher.

Appropriate? Sarah Burge has given her daughter a £6,000 boob job voucher for her seventh birthday She said: 'Poppy begged me for a boob job, so I gave her the voucher so she can have it after she's 16, when it's legal. 'If she develops naturally big boobs, she can have something else done with it.' The voucher was part of a £12,000 'exotic pamper party' that Miss Burge organised to mark her daughter's birthday.

As well as the breast enlargement voucher, Miss Burge bought her daughter thousands of pounds worth of gifts, including a £250 computer, a £450 pink Swarovski crystal ring and necklace set and the promise of a £4,000 spa break. The main event though, was the breast enlargement voucher. Poppy says: 'I wanted a new computer, a holiday and a voucher for surgery. When I got it all, it was a dream come true. All my friends were jealous. 'I can't wait to be like Mummy with big boobs. They're pretty.'

Editor's note: Have you heard the term "Age appropriate", Ms. Burge? This is absurd....and all sorts of messed up!

"SPY" Imaging system for flap surgery

With a name like the SPY system, you might think that "Q", from the James Bond series, would be introducing the technology with a clipped "Pay attention, 007".

Not the case here, though. Despite the neat moniker, the SPY system is a Canadian-made tool to help surgeons figure out whether tissue is getting the correct amount of blood flow. Using a new twist on a time-honored idea, the system uses a laser to make an intravenous dye called ICG light up, combined with a fancy scanner to enhance the images (shown above) for easy use. In real time, the surgeon can actually watch the dye flow into the flap in the artery, light up the tissue, and return back in the vein, so he/she can feel confident about the condition of the flap. The scanner is a small, mobile unit, perfect for use in the OR or the ICU, which is a big improvement over the clunky, X-ray based angiogram equipment of the past.

In plastic surgery, this gadget comes in very handy for assessing whether microsurgical or pedicle flaps, such as those used in breast reconstruction, are working properly. Clinical testing, done largely here in Florida at the Cleveland Clinic, has shown that the SPY system really gives the surgeon an accurate way to assess the blood flow, with a 95% correlation between imaging and the patient's clinical course.

Impression: Cool stuff that works! Breast reconstruction surgeons should check this out.

Medication reduces breast cancer risk in postmenopausal women

The drug Aromasin appears to cut the odds of breast cancer by 65 percent in high-risk postmenopausal women, new research has found. Unlike other anti-estrogen drugs like tamoxifen, Aromasin doesn't seem to have an increased risk of uterine cancer or blood clots.

Aromasin, an aromatase inhibitor, is currently approved for early breast cancer patients, but is not FDA approved as a preventative medication. Currently, the medication costs $300-400 per month, but will soon be available in generic form. Hopefully, the price will drop.

The new placebo-controlled study, conducted by Canada's NCIC Clinical Trials Group with partial support from Pfizer, involved 4,560 women from Canada, the U.S., France and Spain with a median age of 62.5 years. The women were all post-menopausal and had at least one other risk factor for breast cancer.

After three years, researchers observed 11 invasive breast cancers in the women receiving Aromasin, compared with 32 in the group receiving the placebo, for a 65% reduction. There were also fewer precancerous lesions in the group receiving the drug.

"This may add another potential drug for these women," said Dr. Jennifer Litton, a breast medical oncologist with the University of Texas M.D. Anderson Cancer Center in Houston. "Hot flashes, joint stiffness were more pronounced but it [Aromasin] doesn't have the blood clot and uterine cancer risk."

Bye-bye "Food Pyramid". Hello "MyPlate"!

Say goodbye to the USDA Food Pyramid. The Pyramid, introduced in 1992, has been replaced by a simpler new graphic, the Plate. It's a lot simpler, and easier to understand. There's less emphasis on grains, and more emphasis on fruits and vegetables, which now make up one-half of the plate. It's all part of the USDA's new "Dietary Guidelines 2010" program.

Other key messages from the program include:

- Balancing Calories
● Enjoy your food, but eat less.
● Avoid oversized portions.

- Foods to Increase
● Make half your plate fruits and vegetables.
● Make at least half your grains whole grains.
● Switch to fat-free or low-fat (1%) milk.

- Foods to Reduce
● Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers.
● Drink water instead of sugary drinks.

There's much more information and other resources here.

Clever public service announcement about the dangers of tanning

"You look great in leather!" I see that leathery sun-damaged skin too often, here in sun-drenched Florida! And it's hard to fix!

In all seriousness, though, here are some tips about how to preserve your skin from sun damage and avoid skin cancers, from skincancer.org

- Seek the shade, especially between 10 AM and 4 PM.

- Do not burn.

- Avoid tanning and UV tanning booths.

- Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.

- Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.

- Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.

- Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.

- Examine your skin head-to-toe every month.

- See your physician every year for a professional skin exam.