The quantity of operations on increase in a breast which cost on the average about 4 thousand dollars, as a whole on the country has fallen in 2007 from 400 thousand to 355,671. The number of operations on stomach plastic, each of which manages approximately in 5400 dollars, too has decreased – on 37,943. The number of operations on plastic of eyelids – to 45659 for a year has decreased also. Even injections ботокса began to do less: in 2007 – 2,7 million, and in 2008 – 2,4 million. Total number of cosmetic surgical operations in the USA has fallen from 11,8 million in 2004 to 10,2 million in 2008. Recently patients reluctantly go on operation which demand the long period of restoration, and choose such procedures which give fast effect is more often.

For example, laser дермабразия – a rejuvenation of a skin by means of the laser – too completely not cheap procedure which manages from one to two thousand dollars. But the number of these operations has grown for a year on 12 %. In difficult economic conditions young men go on cosmetic operations more often, than earlier. Two thirds of citizens at the age from 18 till 24 years positively concern cosmetic surgery though deterioration of an economic situation has led to appreciable reduction of total wishing to take advantage of services of cosmetic surgeons.

People of both sexes at the age from 25 till 34 years have appeared the most inclined to carrying out of cosmetic surgical interventions. Despite last year’s reduction of number of operations, breast plastic there is in cosmetic surgery operation number one, leaving far behind even липосакцию.

The recommendations, which are endorsed by the American Psychiatric Association, include:

• early and repeated screening for depression in heart patients;
• the use of two questions to screen patients -if depression is suspected the remaining questions are asked (9 questions total);
• coordinated follow-up for both heart disease and depressive symptoms in patients who have both.

“The statement was prompted by the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook,” said Erika Froelicher, R.N., M.A., M.P.H., Ph.D., a professor at the University of California San Francisco, School of Nursing and Medicine and co-chair of the writing group. Dale Briggs, who experienced depression after his heart valve surgery, said the statement is welcome news. “I think it’s long overdue. It is unfortunate that some patients aren’t warned of the possibility of some depression after surgery,” he said.

Briggs is the volunteer executive vice president of Mended Hearts, Inc., a national non-profit organization affiliated with the heart association, offering resources and support for heart surgery patients. He shares his experience with new cardiac patients during hospital visits – one of the main patient-to-patient support services offered by Mended Hearts.

“Since my surgery, I’ve visited about 1,000 patients. During a visit I always let patients know that this may happen, and encourage them to talk to their doctor about getting treatment,” he said. “I’ve had a number of people call me through the years and thank me for warning them about the possibility of depression.”
Experts say depressed cardiac patients have at least twice the risk of second events in the one to two years after a heart attack. Furthermore, studies have shown that more severe depression is associated with earlier and more severe second cardiac events, Froelicher said.

For example, one study found that 15 percent to 20 percent of hospitalized heart attack patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. An even greater proportion showed more depressive symptoms than usual in the population, though not sufficient to meet these criteria. The study also found that some subgroups of patients, such as young women with heart disease, seem particularly vulnerable to depression.

“Studies show that depression is about three times more common in patients following a heart attack than in the general community,” said Judith H. Lichtman, Ph.D., M.P.H., writing co-chair of the statement and associate professor of epidemiology at Yale University School of Medicine in New Haven, Conn. “Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment”. Although depression was mentioned in earlier American Heart Association scientific statements, this is the first to specifically target the condition. Lichtman said more research is needed to determine why depression is associated with poorer outcomes.
Recent studies indicate that depressed patients are less likely to take their medicines as directed, improve their diets, exercise and attend cardiac rehabilitation sessions, all of which could contribute to a worse outcome, Lichtman said.

It’s also possible that biological changes associated with depression such as reduced heart rate variability and increases in blood factors that encourage clot formation could increase risk, the statement said.
Other recommendations in the statement include:

• Patients who have depressive symptoms should be evaluated by a professional qualified in diagnosing and managing depression, and should be screened for other psychiatric disorders, such as anxiety;
• Treatment options include cognitive behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs or combinations of those treatments;
• Selective serotonin reuptake inhibitor (SSRI) treatment soon after a heart attack is considered safe, relatively inexpensive and may be effective for treating depression;
• Routine screening for depression in coronary heart disease patients should be done in multiple settings, including the hospital, physician’s office, clinic and cardiac rehabilitation center, to
  avoid missing the opportunity to effectively treat depression in cardiac patients and improve physical health outcomes;
• Coordination of care between health providers is essential for patients with combined medical and psychiatric diagnoses.

“Depression and heart disease seem to be very much intertwined,” Lichtman said. “You can’t treat the heart in isolation from the patient’s mental health. “There is no direct evidence yet that treating depression improves coronary heart disease outcomes, but plenty of evidence shows that having depression worsens those outcomes. By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it”.

Co-authors include J. Thomas Bigger, Jr., M.D.; James A. Blumenthal, Ph.D., ABPP.; Nancy Frasure-Smith, Ph.D.; Peter G. Kaufmann, Ph.D.; Francois Lesperance, M.D.; Daniel B. Mark, M.D., M.P.H.; David S. Sheps, M.D., M.P.H.; and C. Barr Taylor, M.D. Individual author disclosures are included on the manuscript.

Vascular Insights LLC ( http://vascularinsights.com) of Madison, Conn., engages in the design, development, manufacture, and marketing of medical devices for the minimally invasive treatment of peripheral vascular disease.
In May 2008 the company announced that it had received 510(k) clearance from the U.S. Food and Drug Administration (FDA) to market its ClariVein(TM) infusion catheter for infusion of physician-specified agents in the peripheral vasculature.

ClariVein(TM) is a percutaneous, 2-2/3 Fr (0.035″) catheter, containing a rotating wire, driven by a motor, that enhances fluid dispersion in the treatment area.
The company was co-founded by John P. Marano, Jr. and Dr. Michael Tal, based on Dr. Tal’s insights into interventional procedures. Dr. Tal is chief medical advisor to the company and associate professor of radiology at Yale University School of Medicine.

Jean Jerome Guex, MD, FACPh is coauthor of the definitive book on sclerotherapy, Treatment of Varicose and Telangiectatic Leg Veins, 4th Edition. He is Past President of la Societe Francaise de Phlebologie and Treasurer of the Union Internationale de Phlebologie. He is a Member of the American Venous Forum and is a Fellow and Honorary Member of the American College of Phlebology.
Nick Morrison, MD, FACS, FACPh is a world-renowned leader in the field of phlebology who has dedicated his medical practice to veins. He is a fellow with the American College of Surgeons and American College of Phlebology and President-elect of the American College of Phlebology. He established the Morrison Vein Institute in Scottsdale, AZ and is a partner in the Morrison Training Institute for physicians, nurses, and ultrasound technologists.

Neil Scott Sadick, MD, FAAD, FAACS, FACP, FACPh is one of the world’s most recognized dermatologists and the author of over 250 publications. Board-certified in internal medicine, dermatology, cosmetic surgery, hair restoration surgery, and phlebology, he is Clinical Professor of Dermatology at Cornell University Medical College and past President of the American College of Phlebology.

Vascular Insights

The device lines part of the intestines with a thin material similar to Teflon, keeping food from touching the intestinal walls, the company said. “Fundamentally what we’re trying to do is mimic the bypass portion of a gastric bypass procedure. So instead of surgically bypassing the intestine, we’re mechanically bypassing the intestine. And we’re doing that with an impermeable membrane that lines the inside of the intestine,” Stuart Randle, chief executive officer of privately held GI Dynamics, said in a telephone interview.

Doing so appears to influence hormones relating to hunger, feeling full and blood glucose regulation, according to Dr. Jan Willem Greve of Maastricht University Medical Center in the Netherlands, who did company-funded research on the device. It also may delay gastric emptying, which means food stays in the stomach longer and a person feels full longer.

Weight-loss surgery alters the digestive system’s anatomy, reducing the volume of food a person can eat and digest. The most common type is gastric bypass, which makes the stomach smaller and takes food past part of the small intestine. This device does not change how much food a patient can eat. The device is implanted through the mouth, down the throat, through the stomach and into the intestines. The lining covers about 2 feet (60 cm) of the 12-foot (3.6-metre) intestines.

It is being tested in clinical trials to treat obesity and type 2 diabetes. Greve presented findings from a small study at a medical meeting in Argentina on Friday. Twenty-six people in the Netherlands had the device and 11 did not. All followed the same diet. People in both groups on average weighed more than 300 pounds (135 kg). After three months, those with the device lost an average of about 30 pounds (14 kg) compared to 9.7 pounds (4.4 kg) for the others.

The eight people with type 2 diabetes who got the device had their blood sugar levels drop significantly, Greve said. Greve said side effects included minor nausea and vomiting in the week to 10 days after implantation. Randle did not offer a timetable for bringing the device to market, but said it could be years. Gastric bypass surgery costs about $26,000. Randle said the cost for getting this device would be less than $10,000.

Herald Sun

This in-your-face scenario unfolded in the consultation room of a Harley Street clinic last Wednesday afternoon as a female colleague and I investigated the disturbing rise of hard sell practices in the cosmetic surgery industry. It’s been in the news lately, and the news hasn’t been positive. According to the British Association of Aesthetic Plastic Surgeons, an organisation that represents some of the country’s top surgeons, women’s lives are being put at risk.

Put simply, it claims that clinics are using irresponsible adverts to seduce prospective patients into having operations. Further, many of the promotions – such as lunchtime facelifts and discounts for multiple operations – are at best ineffective or at worst dangerous. Some clinics are even reported to be offering five-for-one deals in the hope that women, and increasingly men, will spend far more than they need to.
‘We are very concerned about the quality of adverts in some women’s magazines,’ warned Douglas McGeorge, president of BAAPS. ‘The idea of a lunch-break facelift is tempting, but it simply does not exist, it is impossible.

‘Similarly, offers encouraging people to sign up quickly in order to get discounts are rushing them into procedures before they can fully consider whether the treatment is appropriate for them. ‘The images in many of these adverts have been touched up, and are encouraging false expectations of cosmetic surgery.’
He added: ‘For them [the clinics] it is all about getting people’s money’.

The investigation

This year in Britain, a staggering £1billion will be spent on cosmetic surgery and procedures such as Botox, and the tills are indeed ringing as never before. But is the pursuit of profit putting patient safety at risk?
To find out, I picked up a copy of a popular woman’s glossy, flicked to the classified adverts at the back and booked appointments with four of the country’s biggest clinics. And so it was that at 11.30am on Wednesday last week Alice, my ‘wife’ (for the day), and I found ourselves at the Transform clinic just off Harley Street. In its advert the company boasts that it is ‘Britain’s most trusted cosmetic surgery group’.

It adds: ‘Transform’s expert breast surgeons help you achieve the figure you want. So do their payment options’. Alice tells our alloted ‘patient care co-ordinator’ – a woman whose ironing-board forehead reveals her love of Botox – that she is shortly to turn 30 and wants to find out about a breast augmentation and liposuction. This is despite the fact that she is a slim size 10 with a 32D bust – and, quite frankly, no one in their right mind would say she needs surgery. Funnily enough, none of the clinics we visited felt moved to point this out.

After the spiel about the company (1,000 operations a week) and its private hospital (’it’s like going to a hotel and having your mum on hand’) details of the procedures are outlined. Both, we are informed, are ‘minor surgery’: Alice could have them done together and would go in to the hospital in the morning and be back at home in the evening. ‘Breast enlargement can be done in half an hour – you are in and out,’ the woman tells us. ‘It’s so easy that the surgeons tell me they could teach me to do it in an afternoon’.

And as for liposuction? ‘We have one particular surgeon who is very good with liposuction. It takes quite a big, burly surgeon because it is quite a big work-out for the surgeon because you have got this [thrusting] motion all the time as the fat is sucked out, but for one or two areas you would be in there for an hour or an hour-and-a-half, max’. As for cost, it quickly becomes clear that the more plastic surgery performed at one time, the cheaper it is.

‘Special’ offers

BAAPS has concerns about this. Nigel Mercer, the organisation’s president-elect, recently saw a woman who had undergone a ‘three-in-one’ offer which involved her having a tummy tuck, breast reduction and facelift under a single general anaesthetic. ‘That’s when patients’ lives start being put at risk,’ he said. ‘Adding lots of lengthy operations, during up to four hours’ anaesthesia, means the risk of infection and thrombosis is greater’. The clinics claim the discounts merely reflect economies of scale – the patient needs only one anaesthetic, one bed and one dose of hospital time.

As a result they can offer tempting savings. At Transform, we are quoted £3,400 for two areas of liposuction (inner and outer thighs) and £3,500 for the boob job. But have the two together and the cost comes down to £5,400 – a saving of £1,500. ‘That is a deal called the Bikini Body which was quite popular for people having quite a lot of work done before the summer,’ we are told. ‘We are still running it, so you are fine for that’. Better still, if Alice is prepared to have the operation at short notice then a further discount can be negotiated.

‘If you decide to have the operation really quickly, if we get to the end of the month, and we still have a couple of beds left, I can give you a discount,’ she is told. ‘If you did it within a couple of weeks I could probably get you a discount. We would have beds available in the next two weeks.’

Risky payment deals

Next up is finance. Credit crunch be damned – there are deals on offer in cosmetic clinics that would have Lehman Brothers bankers choking on their P45s. At Transform we’re offered a buy-now-pay-in-six-months deal – ‘just like buying a sofa’ – a 12-month interest-free deal and three, four and five-year deals.
The consultation drawing to a close, it is suggested that we make an appointment with a surgeon so that he can examine Alice. A Mr Khan is recommended. Did we know that he had ‘done’ Chantelle from Big Brother? No, we did not. ‘His consultation style is a little brief,’ says our co-ordinator (who has reassured us that while her love of Botox means she can no longer frown, she can still move her head). ‘He is at the peak of his profession, everyone knows him. You’ll probably get five or ten minutes with him. But that is all he needs. He doesn’t need any longer. All he needs to do is examine you, make sure you are suitable for surgery, try the implants you are happy with and that is it you done’.

The feeling that we are on a conveyor belt – the aim of which is to deprive us of as much money as possible – grows by the minute. Alice promises to check her diary and to call back to make an appointment. We shake hands and leave. A spokesman for Transform said: ‘We do offer discount packages. Liposuction and breast augmentation together is common and, because there is only one trip to theatre and one hospital stay, we can reduce the cost. We never recommend that somebody has more than two procedures at one time. ‘Surgery is never confirmed until the surgeon has been consulted’.

Next stop, a couple of hundred yards away, is The Harley Medical Group. Its full-page advertisement boasts a surgically enhanced brunette in a blue two-piece. ‘Radiate confidence this summer with cosmetic surgery,’ the ad reads. It is another big player in the British cosmetic industry and we’re warned in advance (by the woman from Transform) that they’ll be more costly. Here the initial consultation, free again, is conducted by a nurse. She wears a blue tunic and speaks in a hushed, motherly tone.

But there’s clearly a business edge to her because when Alice fills in a form outlining her medical history she suggests that she might want to tick the box indicating that she is having the procedures for ‘psychological gain’. ‘They have added VAT on to cosmetic surgery, which is one of the new things this year,’ she explains. ‘To avoid it, we give you a little option called ‘raising confidence and well-being’ and if you tick that it exempts you from it.’ It seems that if you claim your procedure is to improve your state of mind, rather than just your embonpoint, then you can skip the VAT.

The nurse carries out a brief two-minute examination of Alice and suggests that, yes, she probably is suitable for liposuction (even though she is a size 10). If she wants to go further then an appointment will be arranged with a surgeon for a £100 fee. Again, she suggests that a breast augmentation and lipo could be carried out together, although the clinic does not offer packaged deals. The boob job would cost £4,290 and two areas of liposuction £3,595. They are, however, offering a ten per cent discount on all surgery between October 1 and December 20. ‘They are doing it at the moment because we have hospital space,’ she says. ‘A lot of patients are wanting to have it done because ten per cent is a lot – £300 or £400.’ Again there are the payment options, including 14 months’ interest-free credit, and the promise of ten per cent off any subsequent surgical procedures.

It seems inevitable that this kind of offer will only encourage women who want surgery but can’t afford it to go ahead anyway, and hope they will be able to magic up the money. In today’s straitened financial climate, it seems like lunacy.

‘He did Jade Goody’s mum. He can’t be a cowboy’
When we contacted the clinic later, a spokesman insisted they take great care over who they admit for various surgeries: ‘Only a Harley Medical Group plastic surgeon, all of whom are on the Specialist Register, is in a position to accept a patient for surgery’. The third clinic of the day is near Fleet Street and is called Make Yourself Amazing (MYA). Its advert features a number of surgically-enhanced celebrities and states: ‘Feel confident, look natural, make yourself amazing. MYA’s team of highly skilled surgeons can boost your confidence and change your life’. Again this initial consultation is free, with a female ‘patient coordinator’ who again explains about the procedures on offer.

She also says it would make sense to have liposuction and the breast augmentation together to save money and recovery time. ‘If the surgeon thought there was any medical risk he would not proceed with it,’ she says. The boob job costs £3,850 for a day case and £4,250 with an overnight stay. Lipo is £3,330 for two areas. ‘If you did have both procedures together then I would recommend staying overnight,’ she says. ‘It would come to £6,550 for the breast augmentation and two areas of lipo’. MYA also offers a number of ‘deals’. One, called Late Space Friday, offers patients £500 off a boob job if they can be flexible about when they have the operation, filling spaces in the surgical schedule.

Their website also boasts a competition offering ‘50 lucky winners’ the chance to win £250 towards their surgical procedure. All they have to do is to answer correctly what procedure Big Brother contestant Imogen – ‘one of our patients’ – had? For those in any doubt, there’s a photo of Imogen with a couple of clues very much to the fore. A spokesperson for MYA said: ‘We do not favour day surgery. If we thought an overnight stay was necessary or there was any increased risk of complication we would always err towards the side of caution. ‘Promotions such as Late Space Friday, were introduced because there were sometimes gaps in the surgeons’ diary. This is simply a way of reducing costs for customers with lower budgets. We do not wish to cooerce patients into quick decisions. We aim to build loyalty and trust.’ And that brings us to the final appointment of the day.

Back on Harley Street and we’re at the Linia clinic – slogan: ‘enhancing the real you’. This time Alice will see both a patient support officer and a surgeon, a Mr Aslam, who we are told on numerous occasions is the star of TV show Extreme Makeover. And as an entirely unexpected bonus, Mr Aslam introduces Alice to one of his recent patients. She is back for a check-up and is more than happy to lift up her top and show off his handiwork. ‘I’d had my breasts done before, but they had ruptured and got smaller, so I went back to the original surgeon and he wouldn’t do them,’ she explains. ‘So I came here and he just said how big do you want to go? How big are they now? God knows, 34E or F? ‘I saw Mr Aslam on the television. He’s such a nice man, a lovely man. He did Jade Goody’s mum and I saw him on Extreme Makeover and I thought if he is doing that then he can’t be a cowboy.’

‘If you decide quickly, I can get you a discount’
The promotional pitch over, Mr Aslam carries out a physical examination on Alice, who is asked to remove her top. He’s professional and friendly and refuses to recommend any particular procedures off the cuff, saying that it has to be a ‘partnership between you and me’. He explains: ‘You have to define why you want certain things done and how you want to see yourself and then I will then examine you and say this is suitable, this is not suitable and perhaps we should do this instead of that.

‘Once you have made your decision then we say this is what you want to achieve and this is how we will achieve this’. They discuss a breast augmentation and liposuction, with him telling Alice that she would only need one area of her thighs done rather than two. Then it’s back to the admin office where we are told the breast op and one area of lipo would cost £5,625, a saving of £1,000 over the two separate costs added together. The patient support officer adds that it’s a busy time of year coming up. Not only has the credit crunch had no apparent effect, but the run-in to Christmas is particularly popular with women wanting surgery. When approached last night, a spokesperson for Linia said: ‘We do not pressurise patients to make quick decisions or to have more done surgically than they need. Our pre and post surgery patients are encouraged to meet to hear each other’s experiences because we are confident in the quality of our services’.

What difference to this booming industry do the glossy advertisements, the money-off deals, the celebrity endorsements and the patter of the carefully manicured saleswomen play? It’s impossible to quantify, but add in the vanities and insecurities of the modern world, and it’s hardly surprising that this billion-pound business is growing bigger by the day.

“Saline breast implants have been the workhorse of breast augmentation because there are many different saline profiles and shapes available, which allows your doctor to achieve a better match to your individual body frame,” said Kotoske.

Saline breast implants also have a flexible fill volume, and are not prefilled. This provides more options for incision placement, as well as a smaller incision necessary for the breast enhancement surgery. Because saline implants are filled after insertion, their final volume can be adjusted making it easier for the surgeon to correct for existing breast asymmetry.

“Saline breast implants are great for women who need correction for asymmetry, or that have reservations about silicone breast implants,” said Dr. Kotoske. “Each patient is different however, and you should always consider the option that is best suited for your body type. “All of our cosmetic surgeries are designed to complement each individual’s face or body for a natural look. At the Cosmetic Surgery Institute we offer the most natural looking cosmetic surgery as possible to give our patients the feeling of confidence that they deserve”.

“Exercise at 500 pounds was walking to the car from the front door of my house,” explains the six-foot Saridis. “Walking up a flight of stairs was a thought. You would think and plan for it, making sure you didn’t forget anything in your car”. And it’s not as if he hadn’t tried to scale down his weight, which he began packing on at age 14.

Over the next two decades, Saridis tried – and initially succeeded – at almost every diet out there. But the pounds always came back, and then some. He did the infamous diet yo-yo, losing 20, gaining 30; trimming off 40, shooting up 70; carving off 80, ballooning up by 100. “I even got to the point where I was scared to diet,” says Saridis, who knew he was staring heart disease and diabetes in the face. “So here I am, I’m 34 years old, my knees are hurting, I’m wearing orthotics, I’m having difficulty getting out of bed in the morning. I decided something had to be done.”

He went to a Toronto cosmetic clinic for a $17,000 out-of-pocket operation to have a band placed around the opening to his stomach, a procedure that severely limits the amount of food he can ingest. And while the surgery has proved successful – at 221 pounds, the 36-year-old is half the man he was -there were no concurrent services to deal with other issues he struggled with, from proper nutrition to physiotherapy to psychological counselling.

“I left there that day with a stomach that could only hold a hard-boiled egg,” says Saridis, whose typical pre-surgery dinner was as much rice as a plate could hold, topped by two or three chicken breasts, maybe salad to fill up the corners and a 500-millilitre tub of ice cream. Any leftovers were gone before bed.

“But who’s going to fix my mind? … I’m feeling full, but I’m eating with my eyes – and there’s no satiety for my eyes”. Saridis, who owns a drycleaning business, decided he could build a better mousetrap. He invested about $4 million to open the Canadian Institute of Bariatric Options, a private Toronto clinic that provides gastric banding surgery via minimally invasive laparoscopic surgery and related services to promote and sustain weight-loss.

Clients pay $18,000 for the day surgery (which is not provincially insured), periodic tightening of the band as weight is lost, and a year of nutritional, psychological, fitness and chiropractic support. “It’s until they feel OK to stand on their own two legs and deal with things,” he says. “Let’s be honest, we don’t have a secret pill to losing weight, nobody does. What we’re teaching is sensibility, what we’re teaching is practicality and helping to implement it into your life”.

Dr. Nicolas Christou, one of Canada’s most renowned bariatric surgeons, says one thing CIBO is doing right is providing nutritional and other services to help patients make a success of their surgery. But Christou argues that CIBO and similar gastric-banding providers cannot call themselves true bariatric clinics because they offer only a single procedure – and when it comes to the morbidly obese, one size does not fit all.

“Bariatric surgery includes the whole spectrum of procedures that are suitable for the individual patient and include backup procedures if procedure A does not work,” says Christou of McGill University in Montreal, noting that gastric banding carries a significant risk of complications, such as the band slipping down on the stomach or erosion of the tissue it encircles.

North America’s gold-standard surgery is gastric bypass, in which a pouch is created and connected to the small intestine, bypassing the stomach. Another standard surgery is biliopancreatic diversion, which reduces stomach size and allows food to bypass part of the small intestine so fewer calories are absorbed. While both are insured services in most provinces, Christou laments that the notion of “bariatric surgery being covered in Canada has to be taken with a grain of salt.”

Waiting lists for surgery have swelled to inexcusable lengths, he says. The average time in Canada is 5.2 years; his own patients at Montreal’s Royal Victoria Hospital face a 13-year wait. One day a week, Christou operates at the private Weight Loss Surgery clinic, which offers bariatric procedures to non-Quebec residents for $15,000 to $22,000. “Even then, I have a waiting list,” he says. Despite the burgeoning demand and the obvious long-term health benefits of weight reduction, the health-care system is doing little to improve access, Christou says. There are only a dozen or so fully trained bariatric surgeons in the country and the specialty is not attracting more. A major reason, he says, is that the procedure remains near the bottom of hospitals’ surgical priority list: his own hospital gives him only one day of OR time a month.

Such lack of accommodation simply mirrors society’s negative attitudes toward the morbidly obese, Christou believes. “The public perception is that these are big, fat slobs that should be on a diet, and ‘Why should I be paying for their treatment?’ The reality is that they are people that have most likely a genetic predisposition to energy conservation,” who are also subject to “maladaptive socioeconomic factors.”

“And you get these people putting on weight and then they feel more depressed,” he says. “They eat more to feel better, and it’s a vicious circle that cannot be broken other than by the mechanical rearrangement of their gastrointestinal anatomy.” A case in point is five-foot-two Yvonne Holland, who turned to gastric banding after the scale hit 240 pounds, despite repeated and frustrating bouts of dieting.

“I’m feeling like I’m doing something and it’s working,” says Holland, 53, a manager for the City of Kingston, who is down to 205 pounds and wants to take off another 50. “I think, for most people, when you’ve tried things and they’ve not worked, you feel like a failure at the end of the day. … You spiral down. “And people who don’t have weight issues don’t get it. To them it’s easy -and it’s not easy. If it were easy, we wouldn’t be in the position we’re in in this country and in North America where the obesity rates are climbing.”

Given that there are about 900,000 morbidly obese people in Canada, many of them desperate for help, it’s no wonder private clinics are opening to fill the void. Still, CIBO’s surgeon Dr. Monali Misra says gastric banding or any bariatric surgery is not for everybody with weight issues. Patients must have a body mass index of 40 or more, or a BMI of 35-plus with two related illnesses, such as high blood pressure and diabetes, to qualify. Surgery is just a tool that must be combined with healthy eating and exercise to be successful, she says.

“If you take in a high-calorie diet, you’re not going to lose the weight,” says Misra, citing the case of a woman with gastric banding who blended up six Big Macs so she could drink them down. “We operate on the stomach, not the brain,” she quips, stressing that her motivation for doing bariatric surgery is to improve patients’ health; enhancing how they look and feel about themselves is a bonus. “I want them to live longer. And that’s what they need to want as well”.

The Whig Standart

I could no longer climb all over the plane like a spider,” said Ms. Campbell. “Actually, performing simple every day routine items was a problem. I couldn’t even wipe off my kitchen table.” Ms. Campbell tried many treatments, including epidural injections for one year. She turned to Roy Vingan, M.D., of Saddle River, a neurosurgeon at Hackensack University Medical Center (HUMC), and discovered the Department of Neurosurgery offered two procedures that would change her life.

• XLIF®, extreme lateral interbody fusion – a new minimally disruptive procedure to provide relief to those suffering from back and/or leg pain. XLIF is a minimally invasive procedure that provides relief to patients who cannot tolerate a traditional open procedure because of the increased risks of longer anesthesia time, blood loss, hospitalization and recovery. It is also a less invasive alternative for patients who have lived with back or leg pain through years of various failed treatments including steroid injections, physical therapy, and pain medication. The XLIF procedure can be successfully completed in as little as one hour, reducing the amount of anesthesia time. It doesn’t require entry through sensitive back muscles, bones, or ligaments.

• AxiaLIF,® Axial Lumbar Interbody Fusion, System – a new lumbar fusion procedure to chronic low back pain sufferers. This minimally invasive approach, called AxiaLIF®, allows patients to be discharged from the hospital the day after surgery, and on average return to work in 15 days. This is a dramatic reduction in hospital lengths of stay, which can otherwise run three to four nights, followed by a one- to two-month recovery period before returning to work. AxiaLIF can be performed on an outpatient basis, with patients able to safely and comfortably return home the same day as their fusion surgery.

“Surgery isn’t the first option. Physical therapies, medications, and epidural injections are the initial treatments suggested. When those alternatives don’t provide the desired results spinal fusion can be considered,” explained Dr. Vingan. “This surgical procedure offers a safe and effective, less invasive alternative to traditional or open spine surgery.”

“People shouldn’t box themselves in by dismissing new procedures. I did my research and met with Dr. Vingan. He spent more than an hour going over my questions and wish list,” said Ms. Campbell. “My last solo flight was in October of 2006. I didn’t want to spend the rest of my life in pain with limited abilities. I wanted an improved quality of life. Too many people spend too much time in pain management when there are alternatives. The surgery was right for me.”

There are blue skies for Ms. Campbell and she’s hoping to get into the air again sometime soon. “Joanne did really well. Patients undergoing these procedures are often walking the same day. The approach being less invasive reduces operative related recovery time and patients are able to begin physical therapy a lot sooner than they would after traditional back surgery,” said Dr. Vingan. “This approach provides greater access to the spine, better visualization during surgery, less tissue disruption and blood loss, and, of course, faster patient recovery. The best part is that patients are no longer suffering from back and leg pain.”

HealthGrades® named HUMC one of America’s 50 Best Hospitals for the second consecutive year. This designation recognizes hospitals that have demonstrated superior clinical quality over a seven-year time period, based upon an analysis of more than 75 million Medicare patient records from 1999-2005. These hospitals have achieved better survival rates and lower complication rates across dozens of medical procedures and diagnoses, from cardiac care to orthopedic surgery, consistently ranking among the top five percent in the nation for overall clinical outcomes. HUMC is the only healthcare facility in New Jersey, New York, and New England to be named one of America’s 50 Best Hospitals. Only one percent of the nation’s hospitals can make this claim.

Paramus Post

Peritoneal surface disease (PSD) appearing from the spread of colon cancer has not traditionally been considered treatable with surgery because of the difficulty of finding and removing all of the cancer, and has been treated with chemotherapy only, leaving those patients with a decreased prognosis and little hope for survival. The study prompts reconsideration of surgical treatment options in these patients and warrants further study into patient selection in this area, according to the lead researcher, Perry Shen, M.D.

The focus of the study was PSD, the development of colorectal cancer on the peritoneum, which is the lining of the abdominal wall. Researchers wanted to know if survival rates similar to those of patients who undergo liver surgery for metastatic colorectal cancer could be achieved by performing surgery to treat patients for PSD from colorectal cancer.

Shen, an associate professor of surgical oncology, and colleagues compared the outcomes of surgical removal of liver metastases from colorectal cancer, which is accepted as the treatment of choice, to the surgical removal of PSD from colorectal cancer. The PSD removal was combined with intra-abdominal heated chemotherapy. They found that patients who were able to undergo complete removal of all PSD, combined with heated chemotherapy inside the abdomen, had no significant difference in survival rates than liver metastases patients who underwent surgical removal. This showed that surgical removal is a viable possibility for some patients with PSD where it had not been considered a good option before.

“Peritoneal involvement has been considered inoperable because it is not a well-defined anatomic area and the lack of accurate imaging makes operative planning uncertain,” said Shen, a fellow in the American College of Surgeons. “What we have found is though this technique is not a treatment option for everyone with PSD, it can produce long-term survival in select patients and should be considered as part of a multidisciplinary approach.”

Nearly 50,000 people will die this year from colorectal cancer, according to the National Cancer Institute. An estimated 150,000 new cases will have been diagnosed in 2008.

“This type of occurrence of colorectal cancer is typically considered incurable … but in some cases, we now know we can extend the survival rate,” Shen said. “We are trying to change current paradigms in oncology. Physicians should refer these patients to a center that has surgeons with this experience who can deal with peritoneal involvement.”

Co-researchers included Kurt Thai, B.S., John H. Stewart, M.D., Russell Howerton, M.D., Edward A. Levine, M.D., and biostatistician Gregory B. Russell, M.S., all of Wake Forest University School of Medicine; and Brian W. Loggie, M.D., of Creighton University Medical Center in Omaha, Neb.

Science Daily

In the segments, Dr. Cohen’s patients share their plastic surgery experience with other women who may be contemplating breast surgery. In September, 2008, Dr. Cohen’s breast augmentation and breast lift patients were featured on WMAR’s ABC2 “Housecalls,” airing at the conclusion of the show called “The Doctors,” produced by Dr. Phil Productions. Patient safety is the primary concern of the surgeons and staff at the Cosmetic Surgery Center of Maryland. A state-of-the-art, certified surgery center and board certified anesthesiologists provide patients with the finest medical care and services.

For more information on breast augmentation, Baltimore, breast lift, breast reduction, tummy tuck, face lifts and liposuction in the Maryland region, please visit Cosmetic Surgery Center of Maryland online at www.cscmd.com.

About the Cosmetic Surgery Center of Maryland:
The Cosmetic Surgery Center of Maryland is a full-service plastic surgery practice in Towson, Md. offering surgical and non-surgical procedures for women and men. Board-certified, Baltimore cosmetic surgeons, Dr. Michael Cohen and Dr. Larry Lickstein, are among the most respected plastic surgeons in the region. Dr. Cohen is most notably recognized for breast surgery while Dr. Lickstein specializes in surgery for the face. In 2008, Dr. Patrick Byrne of Johns Hopkins Medicine joined the practice to perform Baltimore rhinoplasty procedures.

The fully certified surgical center includes a highly-credentialed medical staff and board-certified anesthesiologists. Be Lifestyle, one of the regions only true medspas, offers a full array of skin care, injectables, laser treatments, microdermabrasion and more under the supervision of the practice’s physicians.

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