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Homeopathy At Risk Of Being Lost In Translation
Homeopathy risks being subsumed by modern medicine, argues a historian of science. Not only does this means that homeopathy"s heroes have become mere footnotes in history, but it could limit homeopathy"s potential to contribute to the treatment of today"s pressing medical problems, she says.
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APEX Guides: Helping PBC Leaders To Become World Class Commissioners
The first three guides - Clinical Engagement, Governance and Prioritising Investment - will be launched at the Practice Based Commissioning National Forum, on 1 July. A fourth guide, on Patient and Public Engagement, will be published over the summer and a fifth, on Procurement, is already in the pipeline and expected to be published in September.
News of the day
New York Times Examines Changes In Surrogacy Process In Recent Years
The medical, legal and interpersonal processes involved with a surrogate birth have changed significantly since the controversial "Baby M" case two decades ago, the New York Times reports. In the case, the surrogate was the infant"s biological mother and unsuccessfully sought custody of the child after birth. The Times reports that the legal proceedings in the case helped reinforce the validity of surrogacy contracts, which are now standard practice.Most couples today use a gestational surrogate -- meaning that they have no genetic link to the woman carrying the fetus -- and some choose to maintain friendships with the surrogate after birth. According to the Times, people might choose gestational surrogacy if the woman lacks a uterus, has a malformed uterus, must take medication incompatible with pregnancy, or has had repeated miscarriages or failures at in vitro pregnancies. Male couples or single men might also use this option.Legal protections have strengthened since the Baby M case, although surrogacy remains illegal in some states. State laws also vary in the steps required to ensure that the parents" names, rather than the surrogate"s, are on the child"s birth certificate.Despite an increase in popularity, surrogacy remains "fraught with controversy" over criticisms that compensation to surrogates amounts to "baby selling" and exploitation of low-income women, according to the Times. However, surrogacy advocates say that most women who choose to become surrogates have altruistic motives. Surrogates typically receive between $15,000 and $20,000 as compensation for carrying the pregnancy and undergoing hormonal preparations. The Times reports that reputable agencies and lawyers who specialize in surrogacy help guard against exploitation and spurious motives for seeking a surrogate pregnancy. Prospective surrogates and parents typically undergo psychological screening and legal guidance, and most lawyers require that surrogates meet certain age and health criteria (Brody, New York Times, 7/21).
Diagnostics

NewYork-Presbyterian/Columbia Implants 100th Heart Valve Replacement Without Open-Heart Surgery

Over the last four years, heart specialists at NewYork-Presbyterian Hospital/Columbia University Medical Center have implanted an innovative aortic heart valve replacement using a catheter-based approach that does not require open-heart surgery in a total of 100 patients -- the most of any U.S. medical center to date. Open-heart surgery can require a two- to three-month recovery period, compared to only a few days for the transcatheter approach. The procedures were conducted as part of multiple clinical research studies of the Edwards SAPIEN transcatheter heart valve. Currently ongoing is the PARTNER (Placement of AoRTic traNscathetER valves) trial, a Phase 3 multicenter study led by national co-principal investigators Dr. Martin Leon and Dr. Craig Smith and focused on the treatment of patients who are at high risk or not suitable for open-heart valve replacement surgery. The SAPIEN heart valve, made of bovine pericardial tissue leaflets hand-sewn onto a metal frame, is implanted via one of two catheter-based methods -- either navigated to the heart from the femoral artery in the patient"s leg, or through a small incision between the ribs and into the left ventricle. It is then positioned inside the patient"s existing valve, using a balloon to deploy the frame, which holds the valve replacement in place. Both procedures are performed on a beating heart, without the need for cardiopulmonary bypass and its associated risks. "This breakthrough technology could save the lives of thousands of patients with heart valve disease who have no other therapeutic options," says Dr. Leon, the study"s national co-principal investigator, associate director of the Cardiovascular Interventional Therapy (CIVT) Program at NewYork-Presbyterian Hospital and Columbia University Medical Center, and professor of medicine at Columbia University College of Physicians and Surgeons. Annually, some 200,000 people in the U.S. need a new heart valve, but nearly half of them do not receive a new valve for a variety of reasons. "This study may show that transcatheter valve replacement is a safe and effective alternative to open surgery, which remains the "gold standard" for most patients," says Dr. Smith, study co-principal investigator, interim surgeon-in-chief and chief of cardiothoracic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and acting Chairman of the Department of Surgery and the Calvin F. Barber Professor of Surgery at Columbia University College of Physicians and Surgeons. The transcatheter valve procedures take about 90 minutes, compared with four to six hours for open-heart surgery. In open-heart surgery, the surgeon cuts through the breastbone, stops the heart, removes the valve and replaces it. The PARTNER trial is a prospective randomized study with two separate treatment arms. In the surgical arm, patients are randomized to receive either the Edwards SAPIEN transcatheter heart valve or an Edwards surgical valve via open-heart surgery. In the non-surgical, medical management arm, patients considered to be non-operative are randomized to receive either the Edwards SAPIEN transcatheter heart valve or appropriate medical therapy. The PARTNER trial is designed for patients with severe aortic stenosis -- a narrowing of the valve that restricts blood flow from the heart -- who are not good candidates for surgery due to age or other concurrent health factors. The PARTNER trial is also available at NewYork-Presbyterian Hospital/Weill Cornell Medical Center"s Ronald O. Perelman Heart Institute, led by Dr. Karl H. Krieger (vice chairman of cardiovascular surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the Philip Geier Professor of Cardiothoracic Surgery at Weill Cornell Medical College) and Dr. Shing-Chiu Wong (director of cardiac catheterization laboratories at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and professor of medicine at Weill Cornell Medical College). The Edwards SAPIEN transcatheter heart valve is manufactured by Edwards Lifesciences of Irvine, Calif., which is also funding the study. Jennifer Homa New York- Presbyterian Hospital/Columbia University Medical Center


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