SUDDEN CARDIAC ARREST (SCA)

The recent death of James Gandolfini, who played mafia boss Tony Soprano in the hit TV series The Sopranos, and recent malpractice cases are reminders that healthcare providers need to be on alert for the risk factors of sudden cardiac arrest (SCA).

SCA is the unexpected loss of heart function, breathing, and consciousness. In SCA, the electrical system of the heart fails and, at times, a heart attack may occur concurrently.

About half of people who suffer SCA had no previous symptoms, such as fatigue, dizziness, and racing heart rate. Approximately 325,000 people in the U.S. die from SCA annually. People who smoke or have coronary artery disease, have had a previous heart attack, have high cholesterol, and/or have a family history of heart disease have a higher risk.

 

These tips can help providers avoid misdiagnosis of SCA:

• Consider the possibility of advanced cardiac risk in patients who:

–• Are overweight and unable to control their weight with diet and exercise.

–• Have high blood pressure not responsive to medication.

–• Have evidence of erectile dysfunction.

–• Are glucose intolerant.

–• Have consistently high cholesterol levels.

–• Have a history of alcoholism.

• Take into account other factors associated with SCA, including:

–• Incidence increases with age—men after age 45 and women after age 55.

–• Men are two to three times more likely to have SCA than women.

–• Personal or family history of heart rhythm disorders, congenital heart defects, heart failure, or cardiomyopathy.

–• Use of illegal drugs (amphetamines or cocaine).

–• Nutritional imbalances (low potassium or magnesium levels).

 

BREAST REDUCTION AND ATHLETIC PERFORMANCE

There's a surprising surgery trend many young athletes are undergoing to improve their performance on the field. Experts say breast reduction surgery is becoming a popular way for girls to get a competitive edge.International tennis player Simona Halep, 21, made headlines after disclosing she had a breast reduction three years ago, in part to help improve her game.
Now it's not just professional athletes going under the knife. Carly Mortensen, 19, had the surgery to improve her softball game.
"It just felt uncomfortable for me because I had to wear two sports bras every time," she said. "It was emotionally pretty tough." "We are tending to a lot more young patients who realize there's a surgery out there that can help them, help them feel better and to help them become more athletic," plastic surgeon Dr. Michelle Spring said. According to Cosmetic Surgery National Data Bank statistics, more than 100,000 women had similar surgeries last year.

SURVEY ON PROPHYLACTIC MASTECTOMIES

If you’ve been diagnosed with breast cancer, the last thing you want is for it to come back. That sentiment goes a long way toward explaining why as many as 25% of women with breast cancer --  especially young women -- have been opting to have healthy breasts removed.

In an effort to dig deeper into patients’ decision-making process, researchers from Memorial Sloan-Kettering Cancer Center in New York and various schools and hospitals affiliated with Harvard developed a lengthy survey. They sent it to breast cancer survivors who were already part of on ongoing study tracking younger women who have been diagnosed with the disease. Responses from 123 women were included in the study, which was published in Tuesday’s edition of Annals of Internal Medicine.
The women who took the survey were between the ages of 26 and 40 when they got their diagnosis. All of them had breast cancer in just one breast -- most of the tumors were Stage 1 or Stage 2 – and all of them opted to have their healthy breast removed (a procedure known as a contralateral prophylactic mastectomy). When the women took the survey, they were an average of 2.1 years past their surgeries.
At first glance, their responses seem to tell a good-news story: 97% of them said they knew the risks and benefits of all of their options, 96% had a strong sense of which factors were most important to them, and 93% said they were sure that removing their healthy breast was the right decision for them.
Why did they take such drastic action? The desire to essentially eliminate any risk of cancer developing in the other breast was cited an “extremely important” or “very important” reason by 98% of the women. In addition, 95% said removing both breasts would give them peace of mind, and 94% believed that it would increase their odds of beating breast cancer and contribute to a longer life.
That doesn’t mean everything went completely smoothly -- 33% said they wound up needing more surgeries than they had expected, nearly the same proportion felt more self-conscious about their appearance than they'd thought they would, and 42% said their “sense of sexuality” was worse than they had anticipated. Still, 90% of the women said that if they could do it all again, they would still get the surgery.
So what’s the problem? The researchers suspect that at least some of these women decided to remove their healthy breasts under false pretenses. For instance, women who didn’t have any mutations in the BRCA1 or BRCA2 genes that would put them at higher risk of developing breast cancer estimated that they had a 10% chance of finding a new tumor in their healthy breast over the next five years; the actual risk is only 2% to 4%, according to the study.
Similarly, the women did not seem to fully grasp that they could keep their healthy breast and have the same long-term odds of surviving breast cancer. An editorial that accompanied the study noted that over a 20-year period, no more than 1% of those who decide to keep their healthy breast later die because their breast cancer has spread there.
The survey found that 87% of the women recalled being “extremely concerned” or “very concerned” about the prospect of cancer showing up in their healthy breast at the time they made their decision. This anxiety may have colored their decision-making process, the researchers wrote. It probably didn’t help that only 51% said their doctors talked with them about reasons not to have the surgery.
“Anxiety and fear of recurrence probably influence women during the decision-making process,” the researchers concluded. Doctors may not be telling these women that their risk of developing cancer in a healthy breast is “relatively low.” Even if they are told, they may be “unable to comprehend their low risk.”
The editorial, written by two doctors from the University of Minnesota, put things more bluntly: The high levels of “patient satisfaction” in the survey could be due to women’s “erroneous estimations” of their future breast cancer risk.
“With improved patient education, perhaps the CPM [contralateral prophylactic mastectomy] trends in the United States will plateau or be reversed,” they concluded.

PENIS SURGERY ON THE RISE

Italian men want bigger penises according to a top plastic surgeon.
They might be known as Italian stallions, but new data on cosmetic surgery suggests men in Italy are less confident than we imagined, with the number of surgical procedures to boost men's manhood surging by as much as 25% every year.
A more superficial society is causing a surge in the number of men opting to undergo radical enlargement surgery, Dr Alessandro Littara, director of the Centre for Sexual Medicine in Milan, has claimed.

A top Italian plastic surgeon has claimed demands for penis enlargement surgery have surged

Despite the operation - formally known as penoplasty - costing between £2,500 and £6,000, men are queuing up for the procedure, the surgeon told Adnkronos news agency.
“The demand for these operations is growing constantly,” he said, revealing he has completed more than 300 operations this year alone.
The operation is usually to make penis thicker, he said, but there are "quite a few who want it longer and sometimes both,” he added.
According to Dr Littara, most men don't even need the surgery – or want the operation to satisfy their partners – instead, he claims, society's obsession with looks is increasing insecurities.
“With everyone seeing images of the body the whole time these days, men are more aware and worried about their bodies – all the parts are important, and the genitals are no exception.”
“We’re living in the age of images, with sexual ones very often on the front page,” he told the news agency. “So sex gets more attention and people feel the need to be competitive.”
Dr Littara said Italian men weren’t the only ones worried about what is going on below their belt line.
“It’s an international problem,” he said – a claim backed up by the international survey of penis size published last year by an Ulster University academic.

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RISK FACTORS FOR PLASTIC SURGERY

For patients undergoing plastic and reconstructive surgery procedures, obesity, anemia and postoperative complications—especially surgical and wound complications—are independent risk factors for hospital readmission, reports a study in the September issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS).