The patient’s name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The hospital plans a news conference Wednesday and would not give details until then.

The transplant was the fourth worldwide; two have been done in France, and one was performed in China.

Surgeons not connected to the Cleveland case reacted cautiously since little is known about the circumstances, but generally praised the operation.

“There are patients who can benefit tremendously from this. It’s great that it happened,” said Dr. Bohdan Pomahac, a surgeon at Harvard-affiliated Brigham and Women’s Hospital in Boston who plans to offer face transplants, too.

Dr. Laurent Lantieri, a plastic surgeon at Henri Mondor-Albert Chenevier Hospital, near Paris, who did a face transplant on a man disfigured by a rare genetic disease, said: “This is very good news for all of us that doctors in the U.S. have done this.”

Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life — not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.

Arthur Caplan, a leading bioethicist who has expressed grave concerns in the past about such surgery, withheld judgment on the Cleveland case but said the woman’s doctors should give her the option of assisted suicide if they wind up making her life worse.

“The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell,” said Caplan, bioethics chief at the University of Pennsylvania. “If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying.”

Siemionow’s long and careful preparation should help prevent such a horrific outcome, those familiar with her said. Siemionow, (pronounced SIM-en-now), 58, a noted hand microsurgeon, has been testing the surgical approach and ways to temper the immune system’s response in experiments for more than a decade.

She has considered dozens of potential candidates over the past four years, ever since the clinic’s internal review board gave permission for her to attempt the operation, and has said she would choose someone severely disfigured as her first case.

“She’s a leader in this field. She’s been investigating this for a long time. She has done the most amount of research in small animals looking at this,” said Dr. Warren Breidenbach, a surgeon at Jewish Hospital in Louisville, Ky., who did the nation’s first hand transplant, in 1999. Siemionow trained with him in Louisville.

The world’s first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. She has done so astoundingly well that surgeons have become more comfortable with a radical operation considered unthinkable a decade ago.

Two others have received partial face transplants since then — a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition. Both are believed to be doing well, though details, especially of the Chinese case, have been scant.

In the Cleveland case, “it is very important what kind of recipient they selected,” and how great the need was, Pomahac (POE-ma-hawk) said. “Hopefully it will open the door both to the public and to other centers” wanting to do these operations.

Details of the Cleveland surgery are not known, but surgeons generally transplant skin, facial nerves and muscle, and often other deep tissue. That is done so the new face will actually function and not just be a mask.

In an interview at the Cleveland Clinic in 2005, Siemionow spoke of the terrible need she saw in people horribly disfigured, and how badly it scarred their social and emotional lives, not just their bodies.

“There are no really good alternative therapies for the severely burned or patients with a facial injury or damage,” she said.

Her task now is to prevent organ rejection while managing the risk of infection from taking strong immune-suppressing drugs.

Rejection is a possibility whenever someone receives an organ or cells from someone else because the body regards this as foreign tissue. Two types of problems can result.

The first is graft-versus-host disease, which could happen if the new facial tissue were to attack the recipient’s body. The second is if the patient’s body were to attack the transplanted face, causing inflammation and other problems at the site of the new tissue.

Either of these can be life-threatening. They can come on suddenly, within days or weeks of the operation, or set in slowly.

The Associated Press:

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The groundbreaking technology also means for the first time tissue transplants can be carried out without the need for anti-rejection drugs.

Five months on the patient, 30-year-old mother-of-two Claudia Castillo, is in perfect health, The Lancet reports.

She needed the transplant to save a lung after contracting tuberculosis.

The disease had damaged her airways.

Scientists from Bristol helped grow the cells for the transplant and the European team believes such tailor-made organs could become the norm.

To make the new airway, the doctors took a donor windpipe, or trachea, from a patient who had recently died.

Then they used strong chemicals and enzymes to wash away all of the cells from the donor trachea, leaving only a tissue scaffold made of the fibrous protein collagen.

This gave them a structure to repopulate with cells from Ms Castillo herself, which could then be used in an operation to repair her damaged left bronchus – a branch of the windpipe.

By using Ms Castillo’s own cells the doctors were able to trick her body into thinking the donated trachea was part of it, thus avoiding rejection.

Advanced science

Two types of cell were taken from Ms Castillo: cells lining her windpipe, and adult stem cells – very immature cells from the bone marrow – which could be encouraged to grow into the cells that normally surround the windpipe.

After four days of growth in the lab in a special rotating bioreactor, the newly-coated donor windpipe was ready to be transplanted into Ms Castillo.

Her surgeon, Professor Paolo Macchiarini of the Hospital Clínic of Barcelona, Spain, carried out the operation in June

He said: “I was very much afraid. Before this, we had been doing this work only on pigs.

“But as soon as the donor trachea came out of the bioreactor it was a very positive surprise.”

He said it looked and behaved identically to a normal human donor trachea.

The operation was a great success and just four days after transplantation the hybrid windpipe was almost indistinguishable from adjacent normal airways.

After a month, a biopsy of the site proved that the transplant had developed its own blood supply.

And with no signs of rejection four months on, Professor Macchiarini says the future chance of rejection is practically zero.

“We are terribly excited by these results,” he said.

“She is enjoying a normal life, which for us clinicians is the most beautiful gift.”

Today Ms Castillo is living an active, normal life, and once again able to look after her children Johan, 15, and Isabella, four. She can walk up two flights of stairs without getting breathless.

Professor Martin Birchall, professor of surgery at the University of Bristol who helped grow the cells for the transplant, said: “This will represent a huge step change in surgery.

“Surgeons can now start to see and understand the potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases.”

He said that in 20 years time, virtually any transplant organ could be made in this way.

US scientists have already successfully implanted bladder patches grown in the laboratory from patients’ own cells into people with bladder disease.

The European research team, which also includes experts from the University of Padua and the Polytechnic of Milan in Italy, is applying for funding to do windpipe and voice box transplants in cancer patients.

Clinical trials could begin five years from now, they said.

Between 50,000 and 60,000 people are diagnosed with cancer of the larynx each year in Europe, and scientists say about half them may be suitable candidates for tissue engineering transplants.

BBC NEWS

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The 38-year-old was rendered infertile when her ovaries failed at the age of 15, causing her to suffer an early menopause. After receiving an ovary transplanted from her twin sister, the woman, who lives in London, is expected to give birth this week.

The pioneering surgery will give hope not only to more than 100,000 British women who suffer an early menopause, but also to those undergoing chemotherapy or radiotherapy for cancer. They could now freeze an ovary before beginning the treatment.

The success also raises the possibility of women freezing ovarian tissue to postpone motherhood for social reasons, such as delaying marriage or not wishing to interrupt their careers.

Unlike IVF, the conventional infertility treatment, an ovary transplant not only allows a woman to conceive “naturally” but also restores hormone levels in women who have suffered an early menopause. The hormones produced in the ovaries – oestrogen, progesterone and testosterone – affect the female body in many ways, including prompting monthly periods and protecting the bones from osteoporosis.

After the ovary transplant, the previously sterile woman had periods for the first time in 22 years. In addition to the joy of becoming pregnant, the osteoporosis she had previously suffered showed signs of improvement as a result of restored hormone levels. The woman’s twin, who already has two children, was prepared to sacrifice one of her ovaries to give her sister the chance of becoming a mother. The baby will, genetically, be the twin sister’s child.

The transplant was carried out in America early last year by Dr Sherman Silber, the microsurgery pioneer of the Infertility Center of St Louis in Missouri.

Silber removed the ovary, which is the size of a walnut, from the donor twin using keyhole surgery. He implanted the ovary into the recipient and had to connect tiny blood vessels, one only a third of a millimetre in diameter, to establish blood flow to the organ.

Three months after the transplant the woman began to ovulate normally and her hormone levels were equal to those of her healthy twin after five months. The woman discovered she was pregnant about a year after the transplant.

Silber, who will discuss the pregnancy at a meeting of the American Society for Reproductive Medicine tomorrow, described the reconnection of the arteries and veins in the transplant as “extremely delicate”.

“Reconnecting these blood vessels deep inside the pelvis can be a tactical challenge. The ovarian artery is less than a third of a millimetre in diameter, in fact so small [that] many gynaecologists have never seen it,” he said.

The transplant from an identical twin made it unlikely that the organ would be rejected. Transplants can be extended to close relatives but immuno-suppressive drugs are needed to prevent rejection of the organ.

Gynaecologists have already carried out transplants of strips of ovarian tissue, which have resulted in at least three births. This is the first known pregnancy from a whole ovary transplant, although a series of the transplants has been carried out by Silber. Transplants of these pieces of ovarian tissue last for about three years. Silber believes that a whole ovary could last for up to a decade.

Times Online

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Claudia Mitchell lost her left arm at the shoulder in a motorbike accident.

Her new arm works by detecting movements of a chest muscle that has been connected to the remains of nerves that once went to her real arm.

The first prototype was fitted to double amputee Jesse Sullivan four years ago.

However, the latest version has been significantly improved.

Using it Ms Mitchell, 26, can now fold clothes, eat a banana and do the washing up.

At a press conference in Chicago to reveal her new arm to the world, Ms Mitchell said: “I can move my elbow up and down and I can open and close my hand simply by thinking that that’s what I want to do.”

Big advance

With her older prosthetic arm, she could only do one thing at a time – either bend her elbow or open her hand.

The technology, developed by the Rehabilitation Institute of Chicago (RIC), took about five hours to install.
The ends of the nerves that once controlled the arm were removed from her shoulder and connected to nerves in the chest muscle, some of which conveyed sensation from the skin above.

Over several months the transplanted nerves grew into the muscle tissue.

Once this happened electrodes fixed to a harness worn on the shoulder were able to detect impulses emitted from the nerves into the muscle and forward them to the arm.

These impulses are processed by a computer, which is able to direct the arm to make very precise movements.

Ms Mitchell said: “Before the surgery, I doubted that I would ever be able to get my life back.

“But this arm and the RIC have allowed me to return to a life that is more rewarding and active than I ever could have imagined.

“I am happy, confident and independent.”

She said the arm was heavy, but that was due to extra motors which gave it a greater range of function.

Many could benefit

At present, if Ms Mitchell is touched on the patch of skin on her chest where the nerves to the hand have been re-routed, she feels that her hand is being touched.

The next step will be to develop a way to have the signals come back from the fingers on the prosthetic to the nerves in the chest and then the brain, so that Ms Mitchell can feel pressure, heat or cold, and even a sharp edge.

The Chicago team estimates that the technology could potentially help more than 400 US military personnel who have had amputations after serving in the Afghanistan and Iraq wars.

Todd Kuiken, the director of RIC’s Neural Engineering Centre for Bionic Medicine, said: “It is so rewarding for me as a physician and a scientist to lead research with the potential to positively impact the lives of amputees.”

Ms Mitchell said she was concerned that her new arm looked as attractive as possible.

“When we got the glove that goes over it I asked them if I could put nails on it and they said yes, so I headed straight for the nail salon.

“She (the manicurist) was pretty terrified, she was afraid she was going to mess something up, but I assured her it was OK.”

BBC NEWS | Health | Woman is fitted with ‘bionic’ arm

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Karl Merk, who lost his arms in a farming accident six years ago, said he at first could not believe that the transplant appeared to have been succesful.

“It was really overwhelming when I saw that I had arms again,” said the 54-year-old, who wore a sleeveless black shirt showing clearly where his new arms had been grafted.

“These are my arms, and I’m not giving them away again,” he told reporters at the Munich University Clinic where he remains nearly three months after the 15-hour operation.

Merk is recovering well and can perform simple tasks such as opening doors and turning lights on and off. His ultimate goals are to eat and dress himself — and ride a motorcycle.

“All in all, our wildest expectations have pretty much been fulfilled,” said Christoph Hoehnke, one of the lead doctors.

A total of 40 surgeons, anesthesiologists, nurses and other support staff carried out the 15-hour operation on July 25-26 to graft the donor’s arms on to the body of Merk, who lost his own just below the shoulder in a combine harvester accident.

Doctors said there were good indications of nerve growth in the arms but it could take up to two years before he relearns how to use his hands.

Merk appeared at the news conference Wednesday with lower arms bandaged and supported with a series of straps attached to shoulder pads.

Merk said he was looking forward to going home after four to six more weeks of an intensive program of physiotherapy, electric stimulation and psychological counseling.

There is also still a risk that Merk’s immune system will react, though doctors said so far there was no sign of them being rejected.

The Associated Press: German doing well after 1st double arm transplant

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A cone biopsy can:

* Remove a thin or a thick cone of tissue from the cervix, depending on how much tissue is needed for examination.
* Be used to diagnose and sometimes to treat abnormal cervical tissue. The abnormal tissue is removed and sent to a lab for examination.

A sample of tissue can be removed for a cone biopsy using:

* A surgical knife (scalpel).
* A carbon dioxide (CO2) laser.
* Loop electrosurgical excision procedure (LEEP).

How it is done

A cone biopsy is usually done as an outpatient procedure (you do not have to spend a night in the hospital).

The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups). Your health professional will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

Medication that makes you unconscious (general anesthetic) or that makes the entire genital area numb (regional anesthesia, such as a spinal or epidural) may be used.

A cone biopsy using LEEP may be done in your health professional’s office with an injected medication that numbs the cervix (cervical block). If a cervical block is used, an oral pain medication or pain medication given into a vein (intravenous, or IV) may be used in addition to the local anesthetic.

What To Expect After Surgery

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. Usually you will stay in the recovery area for 1 to 4 hours, and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will usually go home with a sheet of care instructions and who to contact if a problem arises.

Most women are able to return to their normal activity level in 1 week.

After a cone biopsy

* Some vaginal bleeding is normal for up to 1 week.
* Some vaginal spotting or discharge (bloody or dark brown) may occur for about 3 weeks.
* Sanitary napkins should be used instead of tampons for about 3 weeks.
* Sexual intercourse should be avoided for about 3 weeks.
* Douching should not be done.

When to call your health professional

Call your health professional for any of these symptoms:

* A fever
* Moderate to heavy bleeding (more than you would usually have during a menstrual period)
* Increasing pelvic pain
* Bad-smelling or yellowish vaginal discharge, which may indicate an infection

Why It Is Done

A cone biopsy may be done after a Pap test indicates moderate to severe cell changes and:

* The abnormal tissue cannot be seen with colposcopy but was found in cells collected from a biopsy of the cervical canal, or the abnormal tissue seen with colposcopy extends high into the cervical canal. A cone biopsy is done to remove and examine the abnormal tissue.
* The abnormal cells found on a Pap test cannot be seen with colposcopy or found in cells collected from a cervical biopsy. The cone biopsy may be used to diagnose the cause of the abnormal cell changes and remove the abnormal tissue at the same time.
* Cervical cancer is suspected based on Pap test results, colposcopy, and cervical biopsy. A cone biopsy can determine the extent, depth, and severity of the cancerous tissue and can guide treatment decisions.

How Well It Works

The cone biopsy may remove all of the abnormal tissue. This would mean that no further treatment is needed other than follow-up Pap tests.

The edges of the cervical tissue removed by a cone biopsy may contain abnormal cells, meaning that abnormal tissue may be left in the cervix. The cone biopsy may be repeated to remove the remaining abnormal cells. If follow-up tests show normal cells, then no further treatment may be needed. If abnormal cells remain, you and your health professional may discuss other treatments, such as removal of the uterus (hysterectomy).

The cone biopsy may show cancer that has grown deep into the cervical tissue (cervical cancer). Further treatment, such as surgery, radiation, or chemotherapy, will be recommended.
Risks

A cone biopsy is a surgical treatment with some risks.

* After surgery, a small number of women (less than 10%) may have bleeding that requires vaginal packing or a blood transfusion.1
* Narrowing of the cervix (cervical stenosis) that causes infertility may occur (rare).
* Inability of the cervix to remain closed during pregnancy (incompetent cervix) may occur, causing pregnancies to end in miscarriage or premature labor (rare).

What To Think About

Cone biopsy (conization) can be done using a carbon dioxide laser or loop electrosurgical excision procedure (LEEP). One possible disadvantage of these methods is that the abnormal tissue at the margin with the normal tissue can be changed by the heat from the laser beam or the wire loop. This may make the laboratory study of the biopsied tissue more difficult.

If you have a cone biopsy, you need regular follow-up Pap tests and colposcopic examinations. A Pap test should be repeated every 4 to 6 months or as recommended by your health professional. Once several Pap test results are normal, you and your health professional can decide how often to schedule future Pap tests.

The healing and scarring process after a cone biopsy may make it difficult to identify abnormal tissue in the future.

Cone biopsy (conization) for abnormal cervical cell changes – Yahoo! Health

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In the largest study to date comparing the two medical devices, researchers from Harvard Medical School and Brigham and Women’s Hospital followed 7,217 heart attack victims in Massachusetts who were given stents in 2003 and 2004. Each drug-eluting stent patient was matched with a bare-metal stent patient and followed for two years. During this time, 8.5 percent of the 4,016 patients who received the drug-eluting stents died, compared to 11.6 percent of the 3,201 bare-metal stent recipients. The incidence of second heart attack was also lower in the drug-eluting stent group; 7.4 percent compared to 8.5 percent of those getting bare-metal stents. In addition, only 10.7 percent of the drug-eluting stent patients required a repeat procedure, compared to 14.9 percent of those receiving bare-metal stents. “We conducted this study to understand whether drug-eluting stents are safe in this situation. It is very reassuring that drug-eluting stents were actually associated with better survival and fewer repeat procedures,” said study author Dr. Laura Mauri, an assistant professor of medicine at Harvard Medical School and an interventional cardiologist at Brigham and Women’s Hospital.

The lower rate of repeat procedures probably contributes to the higher survival rate, as do the anti-clotting medications, explained Dr. Mauri. While not all patients may be able to tolerate those drugs, as many as 80 percent of heart attack victims could benefit from the drug-eluting devices, she said.

Some studies have cast doubt on whether drug-eluting stents are better than bare-metal stents. One study in particular, released late last year by Danish researchers, linked drug-eluting stents to the development of potentially fatal blood clots. “There were concerns about the long-term safety of these stents compared with bare-metal stents,” said study author Dr. Laura Mauri, an assistant professor of medicine at Harvard Medical School and an interventional cardiologist at Brigham and Women’s Hospital. “We were looking to see if there was a risk, and we actually saw there was a benefit.”

According to the U.S. National Institutes of Health, of the 1 million stents implanted in U.S. patients annually, about half are used for heart attack victims. One important reason why a bare-metal stent is implanted after a heart attack is fear that the patient might not follow advice to take the clot-preventing drug clopidogrel. “Patients present emergently and there’s less time for the physician to be able to really go through a discussion of ability to take those medications and ability to comply with the therapy long term,” Dr. Mauri said. “If they can’t take clopidogrel long-term, there may be a higher risk of thrombosis.”

The study researchers conclude that, while the drug-eluting stents work better on average, the choice of stent still requires careful consideration of each individual patient’s condition.

The study findings are reported in the September 25 issue of the New England Journal of Medicine and are expected to be released at the American Heart Association meeting in November.

Medical Updates – Drug-Coated Stents Beneficial for Heart Attack Victims | Health News

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“There is no reason to think these face transplants would not be as common as kidney or liver transplants one day,” said Dr. Laurent Lantieri, one of the French doctors who operated on a man severely disfigured by a genetic disease.

In Friday’s issue of the British medical journal Lancet, Lantieri and colleagues reported on their patient’s status one year after the transplant. Chinese doctors also reported on their patient, two years after his surgery.

Last year, the French team operated on a 29-year-old man with tumors that blurred his features in a face that looked almost monstrous. They transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.

The Chinese patient had part of his face ripped off by a bear. Surgeons in Xian gave him a new nose, upper lip and cheek from a donor. After a few months, he could eat, drink and talk normally, and returned home to Yunnan province in southwest China.

The patients were not identified although photos were included in the reports.

As is the case with all transplants, doctors use immune-suppressing drugs to prevent the recipient’s body from attacking the donated tissue. In both face transplants, the patients started rejecting the transplanted tissue more than once. Their doctors solved the problem by juggling their medications.

The French patient now takes three pills a day to prevent rejection.

“That’s less than most people with diabetes,” said Lantieri, a plastic surgeon at the Henri Mondor-Albert Chenevier Hospital in suburban Paris.

Other doctors were reassured by the results.

“To be able to wean down the dosage of the medication in small amounts and relatively quickly, that is encouraging,” said Dr. Bohdan Pomahac, a plastic surgeon at the Brigham and Women’s Hospital in Boston.

Pomahac has permission to do a face transplant in the U.S., as do doctors at the Cleveland Clinic.

Experts have worried that if patients take lifelong anti-rejection drugs after a transplant, their cancer risk will jump. Some also predicted that rejection would destroy the face within a few years. Those fears seem to have been allayed, Pomahac said.

With three successful partial face transplants so far — including the world’s first on a woman whose face was bitten off by a dog in France — doctors say that some of the surgery’s initial uncertainties, like how functional the new face would be, are being answered.

For example, Lantieri’s patient’s face was paralyzed by tumors for more than a decade. The French team wasn’t sure if nerves could grow after the transplant. But they discovered later their patient could blink, proving the brain was able to restore long-forgotten facial nerve connections.

Not everyone is convinced that face transplants are so revolutionary.

Dr. Patrick Warnke, a plastic surgeon at the University of Kiel in Germany, calls them a “dead-end road,” because he doesn’t think the rejection problem can be solved. Instead, he hopes to re-grow tissue from patients’ own stem cells.

Still, the biggest obstacle to more face transplants may not be scientific, but social.

“When kidney transplants first began, people were reluctant to donate because there were a lot of cultural, social and religious issues,” Pomahac said. “This is exactly the same scenario now.”

Doctors plan to do more face transplants, but are having a hard time finding donors.

“Everyone says they would accept a face transplant if they were disfigured,” Lantieri said. “The real question is, would you be a donor, or would you allow your family member to donate their face? That is the answer we need to change.”

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While helping show the statistics involved for the use of CM among cancer patients and survivors, the recent article says, "Previous studies have relied on limited data, focusing on patients in active treatment, small sample sizes and single or few cancer types." One such study has focused on just a few types of cancer, but its limited data is not bad news for acupuncturists or patients.

With its debut at the American Society of Clinical Oncology annual meeting earlier this year in Chicago, a new study was released specific to acupuncture’s help in the cancer fight. The research was limited to head and neck cancer patients. More invasive studies still have to be done but the study using acupuncture—a therapeutic remedy using tiny needles inserted into many points all over the body—along with radiation and surgery have fared well in clinical trials.

Most head and neck cancers are usually treated with a neck dissection—a surgical procedure to remove lymph nodes in the neck that may be cancerous—some of these can involve removing all the lymph nodes as well as muscles in the neck that could be harmed by tumors and then most patients follow up surgery with radiation to shrink the tumors. Patients often complain of severe cases of dry mouth, nausea, chronic pain (especially if their muscles and nerves were removed), and vomiting due to the radiation therapy.

The study Acupuncture Reduces Pain and Dysfunction in Head and Neck Cancer Patients after Neck Dissection done by Dr. David Pfister of the Memorial Sloan-Kettering Cancer Center picked 70 random patients to research over a period of four weeks. All the patients had been recovered from radiation and surgery for three months prior to the study. They were put into two groups: acupuncture and usual care (physical therapy and/or anti-inflammatory drugs). The acupuncture group had a 39 percent improvement in dry mouth, pain and movement dysfunction over the usual care group which had only a 7 percent improvement.

Even though the acupuncture group percentage is significantly higher, it seems that the major symptoms improved were dry mouth and dysfunction as well as general pain. While this is a great advancement in the CM world, the work isn’t over yet. Dr. Pfister comments, "Chronic pain and shoulder mobility problems are common after such surgery, adversely affecting quality of life as well as employability for certain occupations, unfortunately, available conventional methods of treatment for pain and dysfunction following neck surgery often have limited benefits, leaving much room for improvement."

Dr. Cassileth, another doctor on the team at Sloane-Kettering, reminds readers that acupuncture doesn’t always work for everyone, but if a patient plans to go, make sure to go to a certified acupuncturist from a national agency or by one that specializes in specific cancer and cancer treatments.

The American Cancer Society (ACS) also recently reported in a study of over 4,000 survivors of ten different types of cancer, that acupuncture is being used as an alternative to pain medication. Co-author Ted Gansler of the ACS and CANCER peer journal reports, "Surprisingly, other methods such as acupuncture…were used by fewer than 2% of cancer survivors, even though recent studies found them to be useful in relieving some cancer-related symptoms, such as pain."

Maybe if the media keeps poking around the subject, more and more cancer survivors will be aware that acupuncture is a valid alternative source to pain medications and other conventional methods.

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Now a major study shows going through the wrist instead can significantly lower the risk of bleeding — without the discomfort of lying flat for hours while the incision site seals up.

Just one in 100 angioplasties is done via the wrist, and the approach isn’t for everyone. But Monday’s study promises to spur more specialists to use the method.

“In experienced hands, it can be done more,” said Dr. Sidney Smith, heart disease chief at the University of North Carolina at Chapel Hill and a past president of the American Heart Association, who wasn’t part of the study. “This approach, when done by experienced operators, has advantages.”

Angioplasty is prized as a quick, minimally invasive way to restore blood flow in a clogged artery. A tiny balloon is inflated at the site of the blockage, pushing back the clog. Doctors often also insert a mesh tube called a stent to keep the artery propped open. It can be done during a heart attack, to alleviate worsening symptoms that signal a heart attack is imminent, or for nonemergency relief of recurring chest pain.

Who’s the best candidate for an angioplasty versus other treatments is hugely controversial. But once that decision has been made, the new study addressed whether the through-the-wrist route works as well.

Cardiologists have preferred working through the femoral artery in the groin because it is a larger blood vessel than the wrist’s radial artery, easier to tug catheters through. When the procedure’s over, heavy pressure — often a sandbag — is applied for several hours until the puncture site quits bleeding and essentially seals itself. But heavy bleeding and related complications are a risk, happening in anywhere from 2 percent to sometimes as many as 10 percent of patients.

Catheters have gradually gotten smaller and more flexible, and previous small studies had suggested the wrist approach could be safer because that puncture site can be bandaged. In one earlier study, the wrist method even trimmed hospital costs because patients were discharged sooner.

So Duke University researchers turned to a national registry — analyzing more than half a million angioplasties performed at 600 U.S. hospitals between 2004 and 2007 — to see how often wrist angioplasties are done, and the results.

One key caveat: These were first-time, non-emergency cases.

But just 1.3 percent of the angioplasties were done through the wrist. Both methods were equally effective at clearing heart arteries, lead researcher Dr. Sunil Rao reported in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The wrist method cut the bleeding risk by nearly 60 percent: Nearly 2 percent of patients treated the usual way bled, compared with slightly fewer than 1 percent of those treated via the wrist.

The method may be gaining steam: In early 2007, the researchers measured a sudden jump, as the wrist method accounted for about 3.5 percent of angioplasties performed then.

Rao himself uses wrist angioplasty almost exclusively, but it takes extra training that many cardiologists haven’t received.

Still, the heart association’s Smith said training isn’t difficult, and the need may be growing: Obesity can limit traditional access, plus more patients today have disease-damaged leg arteries.

“The procedure is not one that would be recommended for everybody,” Smith cautioned. But, “there are definitely groups of patients where this can be done with the same results and fewer complications.”

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