By : Kevin Pho
The American College of Obstetricians and Gynecologists (ACOG) recently released their recommendations for breast cancer screening.
Previously, they had recommended a mammogram every 1 to 2 years for women between the ages of 40 to 49.
Now, they recommend more intensive screening:
Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when caught early, The American College of Obstetricians and Gynecologists (The College) today issued new breast cancer screening guidelines that recommend mammography screening be offered annually to women beginning at age 40. Previous College guidelines recommended mammograms every one to two years starting at age 40 and annually beginning at age 50.
This contradicts the 2009 recommendation from the USPSTF, which recommended an individualized approach and against routine screening for women aged 40-49.
No wonder patients are confused.
In our society, which values tests and generally believes that earlier cancer detection is better care, the ACOG recommendations were met with media acclaim.
Gary Schwitzer, for instance, points out the bias in CNN’s reporting the guidelines, and specifically takes senior medical correspondent Elizabeth Cohen’s Tweet on the issue to task:
On many occasions that we’ve written about on this blog in recent years, CNN has demonstrated a bias in favor of screening – touting benefits, minimizing harms. Sanjay Gupta’s badgering of US Preventive Services Task Force member Lucy Marion will always stand out in my mind – and in the minds of many of who saw it – as opinionated “attack” journalism that reflects the polarization we often see in politics now creeping (leaping?) into health care and into health care journalism.
As to which guideline to believe, physicians will be divided. I suspect that physicians who practice more strict evidence-based medicine will go with the USPSTF recommendations, while gynecologists will follow their college’s more aggressive recommendations.
Although I’m a proponent of clinical guidelines, obtaining the needed consensus will be difficult. There are too many proverbial cooks in the pot, with every medical society releasing potentially conflicting recommendations and confusing both doctors and patients.
@KevinMD
Showing posts with label Obstetrics-Gynecology. Show all posts
Showing posts with label Obstetrics-Gynecology. Show all posts
Tuesday, July 26, 2011
Monday, May 16, 2011
Phyllodes Tumor
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| Findings: Mammogram shows a lobular hyper dense mass with partially circumscribed and partially obscured margins. No calcifications visible |
Key point: Large rapidly growing circumscribed mass without calcifications
Mammography :Phyllodes tumors appear as a dense, round or oval masses with circumscribed or lobulated borders on mammography. Indistinct margins favor malignant transformation. Calcifications are rare but when present are coarse.
Ultrasonography: demonstrates an oval, round, or lobulated hypoechoic mass. Cystic spaces favor malignancy. Increased vascularity can be common .
T1W1/T2W1 :Phyllodes tumors appear heterogeneously hypointense on T1WI with slit like areas of increased T2WI representing fluid. Enhancement is typically rapid and suspicious kinetics can be observed in approximately 33% of cases.
Differential Diagnosis:
Typically occurring in younger women, fibroadenomas also appear as oval or lobulated mass but have dense, coarse calcifications, homogeneous echogenicity, and more moderate enhancement characteristics.
While there is some overlap with phyllodes tumors demonstrating malignant transformation, breast carcinoma is more likely to demonstrate indistinct margins. Pleomorphic calcifications also favor carcinoma.
Primary sarcoma of the breast is distinguished from phyllodes tumors by the absence of epithelial components. The clinical course of primary sarcoma of the breast is similar to malignant phyllodes tumors.
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| Ultrasound shows an irregularly shaped mass with heterogeneous echogenicity and ill-defined borders. |
Treatment: is by surgical excision with greater than 1 cm margins. Mastectomy may be required for large tumors. Axillary node dissection is usually unnecessary. With respect to adjuvant therapy, radiation reduces local recurrence. Chemotherapy has demonstrated no benefit.
Sunday, January 30, 2011
10 Doctors Who Shamed Their Profession
If you think about it, the comparison of doctors to mechanics is pretty apt. Given the specialized nature of their work and the general helplessness of most patients, doctors, like mechanics, are rarely held accountable for their actions. Sure, for the most part, doctors have your best interest at heart, but like in any profession, there are both good and bad apples. According to the National Patient Safety Foundation, 42 percent of people believed they had personally experienced a medical mistake. Additionally, numerous statistics have shown that a staggering amount of people die each year due to medical error. The following doctors made such blatant mistakes and/or lapses in judgment that they, at the very least, have a reputation that garnered them recognition on this list.
1.Dr. Earl Bradley, Monster: Nothing is worse than violating the trust of a child, which is why Bradley, a former pediatrician from Lewes, Delaware, is such a monster. In February of 2010, he was indicted on 471 charges of child sex abuse involving 103 children. Initial allegations against Bradley surfaced during the mid-’90s, but the hospital for which he worked was unable to verify the claims. They were enough, however, to prompt him to move to Delaware, where more allegations surfaced a decade later, including that he had abused his own son. Bradley was initially arrested in December of 2009 after a year-long investigation, which prompted the indictments two months later.
2.Dr. Robert Ricketson, Screw Up: Ricketson is no longer practicing medicine and the world is better for it. During a spine operation he performed on 73-year-old Arturo Iturralde in 2003, Ricketson intentionally inserted a piece of a screwdriver into the patient’s spine instead of a titanium rod. The rod he had intended to use went missing prior to the surgery, so he took it upon himself to improvise. As a result, Iturralde endured three additional surgeries to insert the proper rod and correct complications. After one of the operations, pieces of the screwdriver were recovered by nurses and the family was alerted. Iturralde became a paraplegic and died two years later, and his family was awarded $5.6 million in a malpractice lawsuit in 2006. During the aftermath, it was discovered that Ricketson’s medical license had been suspended in Oklahoma and Texas and he was denied consideration for a medical license in Kansas in 2002, a year after the botched surgery. He had previously been sued for malpractice several times and had history of narcotics abuse. Not a very impressive resume to say the least.
3.Dr. Jan Adams, Plastic Surgeon Imposter: Adams is most famous for performing the breast augmentation surgery on Donda West, Kanye West’s mom, that resulted in her death in 2007. But that’s not the only blemish on his record. In a malpractice suit against Adams, a previous patient claimed that she didn’t receive proper preoperative or postoperative care, leading to an infection that needed two more surgeries. What’s more, one patient claimed he got her drunk after a surgery and impregnated her, and another claimed a surgical sponge was left inside of her after a breast augmentation. Adams, who attended Harvard University, never received his diploma despite apparently completing his academic requirements. He’s also not a board certified plastic surgeon despite claiming to be one. How was this guy getting work?
4.Julie Ponder and Connell Watkins, Child Killers: Alternative medicine can be a risky proposition given the unproven nature of many of its methods. Attachment therapy in particular can yield tragic results when taken to an extreme. The treatment is used to remedy attachment disorders primarily suffered by adopted and fostered children who persistently misbehave or display little affection toward their new caregivers. In 2000, 10-year-old Candace Newmaker was killed during such treatment when she was suffocated during an intensive rebirthing session. Wrapped in a flannel sheet by psychotherapists Julie Ponder and Connell Watkins, she told to free herself from it while Ponder and Watkins held her down. She pleaded for her life, but was told by Ponder "You want to die? OK, then die. Go ahead, die right now." Newmaker was declared brain dead the next day due to asphyxia. The entire session was videotaped and presented as evidence against Ponder and Watkins, who were each given 16-year prison sentences — Watkins was paroled in 2008 after serving seven years.
5.Dr. James Burt, Ghastly Gyno: The notorious Dr. Burt was exposed for his harmful and downright bizarre practices in the late 1980s when numerous former patients came forward and initiated lawsuits. Beginning in the late 1960s, Burt took it upon himself to perform "love surgeries" in which he altered his patients’ vulvas without their consent. He justified his work in a book he authored in 1975, explaining that "Women are structurally inadequate for intercourse. This is a pathological condition amenable by surgery." He stated the procedure turns them into "horny little mice," though in reality, many of them suffered sexual dysfunction, infection and required corrective surgeries as a result. A $21 million suit was filed against Burt that couldn’t have come close to covering the physical and emotional damages endured by the at least 40 women he hurt.
6.Dr. Cecil Jacobson, Seed Spreader: As a fertility doctor, it was Dr. Jacobson’s duty to assist women in conceiving, and in the 1980s, it appeared he was doing a pretty good job. His patients reported high success rates due to his use of hCG, a hormone released during pregnancy that causes the typical bodily changes. During the supposed pregnancies initiated by hCG, he would identify the fetuses during an ultrasound, but they would usually "die" after about three months. Patients who suspected something was amiss informed a local television station, which investigated and exposed Jacobson. In the process, they discovered he used his semen to artificially inseminate patients who were told they were matched with an anonymous donor. Genetic testing later showed that he was the biological father of at least seven of his patients’ children. Jacobson, who won the Ig Nobel Prize for Biology in 1992 and claimed to have successfully oversaw the impregnation of a male baboon in the 1960s, was stripped of medical license and sentenced to five years in prison.
7.Dr. Rolando R. Sanchez, Accidental Amputator: To be fair to Dr. Sanchez, he has done a fine job of rehabilitating his reputation after the costly mistake he oversaw in 1995 — in fact, he’s still practicing. Even still, it’s the kind of inexcusable error you’d never wish on your worst enemy. In the process of amputating Willie King’s leg, Sanchez was informed by a nurse that he had cut into the wrong one. It was too late, however, and he had to finish what he started — King would later have the original leg amputated by another doctor. Consequently, Sanchez was suspended on the grounds that he presented an "immediate and serious danger to the health, safety and welfare of the public," and King later settled with the hospital.
8.Dr. Red Alinsod, Organ Tattoo Artist: Ingrid Paulicivic certainly won’t be recommending Dr. Alinsod given what occurred during her June 2009 hysterectomy. According to Paulicivic’s lawsuit, while putting the finishing touches on the surgery, Dr. Alinsod decided to brand his work by using an "electrocautery device to carve and burn" her name into her removed uterus. Alinsod claimed the move was necessary to ensure he wouldn’t confuse the uterus with others. Paulicivic became aware of the branding during a follow-up visit in which she complained of the resulting burns on her legs.
9.Dr. Elias Hanna, Carvey Carver: Dr. Hanna nearly caused the premature death of yet another Saturday Night Live legend. In 1998, he botched Dana Carvey’s heart bypass surgery by connecting a healthy portion of his artery to a healthy diagonal vessel instead of the damaged arterial section. It wasn’t until two months after the operation that Hanna discovered the mistake, resulting in an emergency angioplasty for Carvey — his fourth in less than a year. Before it was corrected, he was susceptible to suffering a fatal heart attack. Carvey filed a medical malpractice lawsuit and eventually settled for $7.5 million.
10.Alan Hutchinson, Dirty Dentist: Hutchinson, a dentist from Batley, West Yorkshire, UK, made headlines in 2007 when he was accused of using sterilized instruments to clean his ears and fingernails, working on teeth without washing his hands or using gloves, and urinating in a surgical sink. Complaints from a patient and his nurse, Claire Pygott, eventually led to a guilty verdict from the General Dental Council in London. Pygott said that she was "shocked, disgusted and appalled" by the dentist’s actions, which she had witnessed on more than one occasion.
Source : http://www.mastersinhealthcare.com/blog/
special thanks to Celina Jacobson
1.Dr. Earl Bradley, Monster: Nothing is worse than violating the trust of a child, which is why Bradley, a former pediatrician from Lewes, Delaware, is such a monster. In February of 2010, he was indicted on 471 charges of child sex abuse involving 103 children. Initial allegations against Bradley surfaced during the mid-’90s, but the hospital for which he worked was unable to verify the claims. They were enough, however, to prompt him to move to Delaware, where more allegations surfaced a decade later, including that he had abused his own son. Bradley was initially arrested in December of 2009 after a year-long investigation, which prompted the indictments two months later.
2.Dr. Robert Ricketson, Screw Up: Ricketson is no longer practicing medicine and the world is better for it. During a spine operation he performed on 73-year-old Arturo Iturralde in 2003, Ricketson intentionally inserted a piece of a screwdriver into the patient’s spine instead of a titanium rod. The rod he had intended to use went missing prior to the surgery, so he took it upon himself to improvise. As a result, Iturralde endured three additional surgeries to insert the proper rod and correct complications. After one of the operations, pieces of the screwdriver were recovered by nurses and the family was alerted. Iturralde became a paraplegic and died two years later, and his family was awarded $5.6 million in a malpractice lawsuit in 2006. During the aftermath, it was discovered that Ricketson’s medical license had been suspended in Oklahoma and Texas and he was denied consideration for a medical license in Kansas in 2002, a year after the botched surgery. He had previously been sued for malpractice several times and had history of narcotics abuse. Not a very impressive resume to say the least.
3.Dr. Jan Adams, Plastic Surgeon Imposter: Adams is most famous for performing the breast augmentation surgery on Donda West, Kanye West’s mom, that resulted in her death in 2007. But that’s not the only blemish on his record. In a malpractice suit against Adams, a previous patient claimed that she didn’t receive proper preoperative or postoperative care, leading to an infection that needed two more surgeries. What’s more, one patient claimed he got her drunk after a surgery and impregnated her, and another claimed a surgical sponge was left inside of her after a breast augmentation. Adams, who attended Harvard University, never received his diploma despite apparently completing his academic requirements. He’s also not a board certified plastic surgeon despite claiming to be one. How was this guy getting work?
4.Julie Ponder and Connell Watkins, Child Killers: Alternative medicine can be a risky proposition given the unproven nature of many of its methods. Attachment therapy in particular can yield tragic results when taken to an extreme. The treatment is used to remedy attachment disorders primarily suffered by adopted and fostered children who persistently misbehave or display little affection toward their new caregivers. In 2000, 10-year-old Candace Newmaker was killed during such treatment when she was suffocated during an intensive rebirthing session. Wrapped in a flannel sheet by psychotherapists Julie Ponder and Connell Watkins, she told to free herself from it while Ponder and Watkins held her down. She pleaded for her life, but was told by Ponder "You want to die? OK, then die. Go ahead, die right now." Newmaker was declared brain dead the next day due to asphyxia. The entire session was videotaped and presented as evidence against Ponder and Watkins, who were each given 16-year prison sentences — Watkins was paroled in 2008 after serving seven years.
5.Dr. James Burt, Ghastly Gyno: The notorious Dr. Burt was exposed for his harmful and downright bizarre practices in the late 1980s when numerous former patients came forward and initiated lawsuits. Beginning in the late 1960s, Burt took it upon himself to perform "love surgeries" in which he altered his patients’ vulvas without their consent. He justified his work in a book he authored in 1975, explaining that "Women are structurally inadequate for intercourse. This is a pathological condition amenable by surgery." He stated the procedure turns them into "horny little mice," though in reality, many of them suffered sexual dysfunction, infection and required corrective surgeries as a result. A $21 million suit was filed against Burt that couldn’t have come close to covering the physical and emotional damages endured by the at least 40 women he hurt.
6.Dr. Cecil Jacobson, Seed Spreader: As a fertility doctor, it was Dr. Jacobson’s duty to assist women in conceiving, and in the 1980s, it appeared he was doing a pretty good job. His patients reported high success rates due to his use of hCG, a hormone released during pregnancy that causes the typical bodily changes. During the supposed pregnancies initiated by hCG, he would identify the fetuses during an ultrasound, but they would usually "die" after about three months. Patients who suspected something was amiss informed a local television station, which investigated and exposed Jacobson. In the process, they discovered he used his semen to artificially inseminate patients who were told they were matched with an anonymous donor. Genetic testing later showed that he was the biological father of at least seven of his patients’ children. Jacobson, who won the Ig Nobel Prize for Biology in 1992 and claimed to have successfully oversaw the impregnation of a male baboon in the 1960s, was stripped of medical license and sentenced to five years in prison.
7.Dr. Rolando R. Sanchez, Accidental Amputator: To be fair to Dr. Sanchez, he has done a fine job of rehabilitating his reputation after the costly mistake he oversaw in 1995 — in fact, he’s still practicing. Even still, it’s the kind of inexcusable error you’d never wish on your worst enemy. In the process of amputating Willie King’s leg, Sanchez was informed by a nurse that he had cut into the wrong one. It was too late, however, and he had to finish what he started — King would later have the original leg amputated by another doctor. Consequently, Sanchez was suspended on the grounds that he presented an "immediate and serious danger to the health, safety and welfare of the public," and King later settled with the hospital.
8.Dr. Red Alinsod, Organ Tattoo Artist: Ingrid Paulicivic certainly won’t be recommending Dr. Alinsod given what occurred during her June 2009 hysterectomy. According to Paulicivic’s lawsuit, while putting the finishing touches on the surgery, Dr. Alinsod decided to brand his work by using an "electrocautery device to carve and burn" her name into her removed uterus. Alinsod claimed the move was necessary to ensure he wouldn’t confuse the uterus with others. Paulicivic became aware of the branding during a follow-up visit in which she complained of the resulting burns on her legs.
9.Dr. Elias Hanna, Carvey Carver: Dr. Hanna nearly caused the premature death of yet another Saturday Night Live legend. In 1998, he botched Dana Carvey’s heart bypass surgery by connecting a healthy portion of his artery to a healthy diagonal vessel instead of the damaged arterial section. It wasn’t until two months after the operation that Hanna discovered the mistake, resulting in an emergency angioplasty for Carvey — his fourth in less than a year. Before it was corrected, he was susceptible to suffering a fatal heart attack. Carvey filed a medical malpractice lawsuit and eventually settled for $7.5 million.
10.Alan Hutchinson, Dirty Dentist: Hutchinson, a dentist from Batley, West Yorkshire, UK, made headlines in 2007 when he was accused of using sterilized instruments to clean his ears and fingernails, working on teeth without washing his hands or using gloves, and urinating in a surgical sink. Complaints from a patient and his nurse, Claire Pygott, eventually led to a guilty verdict from the General Dental Council in London. Pygott said that she was "shocked, disgusted and appalled" by the dentist’s actions, which she had witnessed on more than one occasion.
Source : http://www.mastersinhealthcare.com/blog/
special thanks to Celina Jacobson
Saturday, January 15, 2011
On Breast Elastography
Breast ultrasound elastography is 12% more sensitive than MR diffusion-weighted imaging (DWI) in determining malignancy of breast masses assessed as BI-RADS category 4, and it's almost 10% more accurate, according to a new study published in the January American Journal of Roentgenology.
Clinicians currently use B-mode sonography and dynamic contrast-enhanced MRI to classify breast lesions based on the standard BI-RADS categorizations. But newer techniques such as ultrasound elastography -- which assesses the softness or stiffness of breast tissue -- and DWI-MRI are being evaluated as adjuncts to these modalities in the hope of better identifying the character of a breast lesion.
Hiroko Satake, MD, of Nagoya University School of Medicine in Japan, and colleagues compared the abilities of ultrasound elastography and DWI-MRI to predict malignancy of breast masses. They found that not only was elastography more sensitive overall, it was more sensitive with lesions smaller than 1 cm -- more than 17% compared to DWI-MRI. In addition, it was more than 10% more accurate (AJR, January 2011, Vol. 196:1, pp. 202-209).
"Because malignant tumors predominantly are harder than benign tissues, [ultrasound elastography] significantly improves the differentiation between benign and malignant tissue," Satake and colleagues wrote. "[Our results] suggest that ultrasound elastography could be used to prevent unnecessary biopsies."
Satake's group included 115 breast masses categorized as BI-RADS 4 or 5; the masses were assessed according to combined findings from mammography, B-mode sonography, and dynamic contrast-enhanced MRI. Two radiologists retrospectively evaluated the elasticity scores of the masses using ultrasound elastography and the apparent diffusion coefficient (ADC) values using DWI-MRI.
"By accurately identifying benign tumors with imaging, we may be able to avoid sending patients for unnecessary biopsies," Satake and colleagues wrote. "Based on the results of our study, we recommend that patients with BI-RADS 4 masses should undergo biopsy if their ultrasound elasticity score is 4 or 5."
Of the 115 breast masses included in the study, 88 were malignant and 27 were benign. The mean diameter of the malignant lesions was 16.1 mm, the team found. The researchers compared BI-RADS assessment categories, elasticity scores, and ADC values between the benign and malignant masses. A lesion's elasticity score proved to be more sensitive and accurate in predicting malignancy than its ADC value, both overall and with lesions smaller than 1 cm.
by : Kate Madden Yee
Wednesday, January 5, 2011
Long after complicated pregnancy, maternal cardiac problems develop
Many years after preeclampsia, women have an increased risk for cardiac dysfunction, Austrian researchers report in BJOG online
The same is true for women who have the so-called HELLP syndrome during pregnancy (hemolysis, elevated liver enzymes, and low platelets).
"Our study shows that even asymptomatic women many years after (preeclampsia or HELLP syndrome) have an increased risk for cardiovascular disease," lead author Dr. Isolde Strobl told Reuters Health by e-mail.
Dr. Strobl and colleagues at Innsbruck Medical University say epidemiologists had suggested this might be the case. To find more evidence, they studied 48 "apparently healthy, asymptomatic women" who were an average of 43 years old, some 13 to 18 years after an index pregnancy. Fourteen women had been preeclamptic, 17 had HELLP syndrome, and 17 had normal pregnancies.
Echocardiography showed that the myocardial performance index (MPI), used to evaluate systolic and diastolic left ventricular function, was significantly elevated in the preeclampsia group (0.36) and the HELLP group (0.34) compared to controls (0.24).
It is not known "whether this elevated risk is a reflection of a common etiology of these diseases, or whether cardiovascular disease in these women is caused by HELLP syndrome or preeclampsia," the researchers write.
Nevertheless, Dr. Strobl said, "Prophylactic measures like lifestyle changes might be essential for these women in order to prevent adverse outcome later in life."
By David Douglas
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