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    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.015"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265790501991"
                     
      &lt;p&gt;Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died yesterday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman&apos;s office.&lt;/p&gt;
&lt;p&gt;He had been admitted to the intensive care unit at Virginia Hospital Center in Arlington on Jan. 31, days after surgeons at the National Naval Medical Center in Bethesda, Md., accidentally nicked his intestine during the operation, according to a report in &lt;em&gt;The Washington Post&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In that same report, Rep. Bob Brady (D-Pa.), a close friend of Murtha&apos;s, said the congressman developed an infection and fever.&lt;/p&gt;
&lt;p&gt;Citing a request for privacy from the Murtha family and patient privacy laws, a spokesperson for the National Naval Medical Center declined to provide information on the operation.&lt;/p&gt;
&lt;p&gt;In a statement, Virginia Hospital Center said Murtha died &quot;despite aggressive critical care interventions.&quot;&lt;/p&gt;


  &lt;p&gt;Mark Malangoni, MD, surgeon-in-chief at MetroHealth Medical Center in Cleveland, told &lt;em&gt;MedPage Today&lt;/em&gt; that serious complications, including bowel damage and death, are not common following cholecystectomy. More complicated patients, such as the obese and diabetics, have a greater risk of complications and of a switch to an open procedure.&lt;/p&gt;
    &lt;p&gt;Death is extremely rare in healthy individuals, occurring in no more than one per 1,000 patients, according to the American College of Surgeons (ACS).
    &lt;p&gt;More common, but still infrequent, are bleeding and leakage of bile, both of which can be treated fairly easily, said Malangoni, a regent of the ACS.&lt;/p&gt;


&lt;p&gt;When the bowel is damaged, as reportedly occurred in Murtha&apos;s case, it typically occurs in two ways -- either from a sharp injury when the trocars used for a laparoscopic procedure are inserted or from a cautery burn.
    &lt;p&gt;Both types of injury can go unnoticed by the surgeon and may not become apparent for days after the operation, Malangoni said.&lt;p&gt;
    &lt;p&gt;Although he did not know the details of Murtha&apos;s case, Malangoni said a patient would usually be admitted right away, at least overnight, if the surgeon realized that an injury had occurred. The procedure likely would have switched from a laparoscopic one to an open one as well.&lt;/p&gt;


&lt;p&gt;A 2009 Cochrane Review comparing laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis found no difference in mortality in 38 trials. No patients died in the laparoscopic group and only 0.09% died in the open group.&lt;/p&gt;
&lt;p&gt;Severe complications were reported in 2.2% of the laparoscopic patients and 6.8% of the open patients.&lt;/p&gt;


 &lt;p&gt;Malangoni said most surgeons become experienced with performing laparoscopic cholecystectomies before completing their residency; most will perform 40 or 50 by the end of training.&lt;p&gt;
    &lt;p&gt;&quot;It is a very common operation, so once out into practice, most general surgeons are doing dozens of these each year,&quot; he said. &quot;So your experience comes about pretty quickly.&quot;
    &lt;p&gt;It is unclear how much experience Murtha&apos;s surgeon had.&lt;/p&gt;

&lt;p&gt;Murtha had recently become the longest serving member of Congress in Pennsylvania state history.&lt;/p&gt;
&lt;p&gt;First elected in 1974, Murtha, a former Marine, was the first Vietnam War combat veteran to serve in Congress, and he served as an advocate for the military throughout his career. He was also a prominent critic of the Iraq War.&lt;/p&gt;
&lt;p&gt;Murtha is survived by his wife, Joyce, and three children.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_226"
                     title="ASCO GI: Blood Test Detects Colorectal Cancer"
                     score="-0"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18079?impressionId=1265790501991"
                     
      &lt;p&gt;ORLANDO  --  A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found.&lt;/p&gt;
&lt;p&gt;The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.&lt;/p&gt;
&lt;p&gt;Further validation for the biomarker would be needed before considering clinical use in surveillance, they cautioned here at the ASCO Gastrointestinal Cancers Symposium.&lt;/p&gt;
&lt;p&gt;But the results were exciting and could represent &quot;a very significant advance,&quot; commented Robert P. Sticca, MD, of the University of North Dakota in Grand Forks.&lt;/p&gt;
&lt;p&gt;&quot;It looks like it may be a very reliable marker for not only the early detection of colon cancer and even precancerous conditions, but also could be used for follow-up for patients who previously had cancer for recurrence,&quot; he said as moderator of a press briefing at which the results were discussed.&lt;/p&gt;
&lt;p&gt;Colorectal cancer screening is effective, with early detection and treatment shown to improve survival.&lt;/p&gt;
&lt;p&gt;However, colorectal cancer is often diagnosed at a late stage with poor prognosis, in part because of &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; target=&quot;_blank&quot;&gt;poor uptake of colonoscopy&lt;/a&gt;, Kraus said at the press briefing.&lt;/p&gt;
&lt;p&gt;Unfortunately, there are no sufficiently accurate blood-based screening tests, he noted, although there have been &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; target=&quot;_blank&quot;&gt;attempts&lt;/a&gt; to develop them.&lt;/p&gt;
&lt;p&gt;Her group had previously found that the CD24 protein  --  expressed on the cell surface, where it plays a role in cell adhesion and metastasis  --  was associated with development of colorectal cancer in a gene expression study.&lt;/p&gt;
&lt;p&gt;So, with two independent cohorts, they tested whether CD24 could be a good biomarker for colorectal cancer.&lt;/p&gt;
&lt;p&gt;The first cohort included 63 patients with colorectal cancer, 19 with adenoma, and 68 controls with a clean bill of health on colonoscopy. Of these 150 individuals, 143 were externally evaluated by a blinded investigator.&lt;/p&gt;
&lt;p&gt;CD24 expression was nearly six-fold higher among adenoma and colorectal cancer cases than among controls, a significant difference. Levels were similar between the cancer and adenoma groups.&lt;/p&gt;
&lt;p&gt;The second cohort included 73 subjects: 38 normal controls, 24 with colorectal adenoma, and 11 with colorectal cancer.&lt;/p&gt;
&lt;p&gt;The test could distinguish colorectal cancer cases from controls with &quot;relatively high&quot; sensitivity and specificity (92.3% and 83.8%, respectively), Kraus said.&lt;/p&gt;
&lt;p&gt;Its performance in detecting adenoma versus normal colonoscopy results was lower, 75.0% sensitivity and 89.2% specificity.&lt;/p&gt;
&lt;p&gt;Kraus said her group is now testing this CD24 approach in a larger sample and developing an enzyme-linked immunosorbent assay (ELISA) that could be more widely used.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_183"
                     title="Gastric Bypass Extends Life for Most Patients (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18020?impressionId=1265790501991"
                     
      &lt;p&gt;For most patients in most categories, bariatric surgery increases life expectancy, according to a new mathematical model.&lt;/p&gt;
&lt;p&gt;Only when short-term mortality following bariatric surgery is expected to be high or the likelihood of success is low will the procedure fail to improve life expectancy, researchers reported in the January &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Computer modeling predicted that a hypothetical &quot;base case&quot; patient  --  a 42-year-old woman with a body mass index of 45  --  would gain 2.95 years of additional survival following bariatric surgery, according to Daniel P. Schauer, MD, of the University of Cincinnati, and colleagues.&lt;/p&gt;
&lt;p&gt;Surgery failed to be beneficial in the model only when 30-day mortality reached 9.5% or the likelihood that surgery would not add life-years was 2% or less, they found.&lt;/p&gt;
&lt;p&gt;Baseline 30-day mortality in the model was 0.2%, and the baseline efficacy of surgery in extending life expectancy was 53%.&lt;/p&gt;
&lt;p&gt;&quot;While not all patients are guaranteed a good outcome, our model indicates that gastric bypass increases life expectancy for most patient subgroups,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;Their analysis was based on a Markov decision model using published data to estimate 30-day mortality following bariatric surgery and the efficacy of surgery in reducing long-term death rates.&lt;/p&gt;
&lt;p&gt;The latter had two components: reduction in excess mortality associated with obesity, and research data on long-term mortality following bariatric surgery.&lt;/p&gt;
&lt;p&gt;Excess mortality estimates came from National Health Interview Survey data on some 400,000 participants from 1991 to 1996 linked to the National Death Index. Inputs on surgery efficacy were derived from a 2007 study of nearly 8,000 patients who had undergone gastric bypass and the same number of medically treated or untreated obese controls.&lt;/p&gt;
&lt;p&gt;That study found that the procedure cut death rates by half during about seven years of follow-up. (See &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; target=&quot;_blank&quot;&gt;Missing Link Found: Bariatric Surgery Reduces Mortality&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Schauer and colleagues obtained rates of inhospital mortality following bariatric surgery from the 2005 National Inpatient Survey, then multiplied them by three to estimate 30-day mortality.&lt;/p&gt;
&lt;p&gt;The researchers explained that according to earlier research, inhospital death rates typically underestimate 30-day mortality by a factor of two to three.&lt;/p&gt;
&lt;p&gt;Their threefold correction factor represents &quot;a conservative estimate that biases the model against gastric bypass surgery,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Schauer and colleagues tested this correction factor and other aspects of the model in sensitivity analyses.&lt;/p&gt;
&lt;p&gt;The biggest gains in life expectancy occurred in younger women with relatively high BMI values, the model showed.&lt;/p&gt;
&lt;p&gt;The age effect was less important than BMI at the time of surgery. A 35-year-old woman with BMI of 45 would gain about 3.2 years of extra life, whereas at 55, a similarly obese woman would gain about 2.5 extra years.&lt;/p&gt;
&lt;p&gt;But a 35-year-old woman with BMI of 55 could expect to live five more years with surgery, the model indicated.&lt;/p&gt;
&lt;p&gt;Men in general derived less survival benefit from bariatric surgery, particularly with advancing age at the time of the procedure.&lt;/p&gt;
&lt;p&gt;At 35, the difference in life expectancy gained was roughly 10%, but by age 75 it had grown to about 50%.&lt;/p&gt;
&lt;p&gt;The sensitivity analyses found that relatively large changes in most parameters used in the model did not affect the overall results substantially.&lt;/p&gt;
&lt;p&gt;The effect of 30-day mortality on whether or not surgery was beneficial for long-term survival was related to BMI and gender.&lt;/p&gt;
&lt;p&gt;For women with a BMI of 40, 30-day mortality of more than 5% would mean surgery was not helpful, but short-term mortality had to exceed 15% for surgery not to be preferable for those with BMI of 55 or more. These thresholds were about 10% higher for men.&lt;/p&gt;
&lt;p&gt;The efficacy of surgery in reducing mortality was less important for older men, the analysis also showed. A 75-year-man with a BMI of 35 could expect only a very slight gain in life span  --  perhaps one or two months.&lt;/p&gt;
&lt;p&gt;&quot;Younger patients have lower surgical risk and more time over which to realize the benefits of surgery. For older patients, the gain is smaller, and for some, gastric bypass surgery will decrease life expectancy,&quot; Schauer and colleagues wrote.&lt;/p&gt;
&lt;p&gt;However, they identified several potentially serious limitations to the analysis.&lt;/p&gt;
&lt;p&gt;The study of long-term mortality following bariatric surgery was conducted at a single center and was not randomized. Additionally, long-term complications, such as need for repeat surgery, were not addressed in the model. Certain other risks that might be heightened after bariatric surgery were excluded as well, and quality of life was not modeled.&lt;/p&gt;
&lt;p&gt;&quot;The decision analysis presented here is a step forward in understanding optimal patient selection but also highlights some of the areas for which better data are needed,&quot; the researchers wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3553"
                     title="Genetic Mutation Tied to Severe IBD (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/tb/16816?impressionId=1265790501991"
                     
      &lt;p&gt;Genetic mutations in interleukin-10 receptors may be responsible for inflammatory bowel disease in patients who inherit the disorder, researchers said.&lt;/p&gt;
&lt;p&gt;In an analysis of two children who had early onset of the disease and their families, the researchers found mutations in genes encoding the IL10R proteins, which make up interleukin-10 receptors, according to Erik-Oliver Glocker, MD, of University College London, and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;The presence of severe inflammatory bowel disease is the most prominent phenotype in patients with IL10R1 or IL10R2 deficiency,&quot; the researchers reported the Nov. 5 issue of the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;We therefore infer that a lack of interleukin-10 signaling is the principal malfunction and is a likely cause of inflammatory bowel disease in patients with IL10R2 deficiency.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Brian Kelsall, MD, of the National Institute of Allergy and Infectious Diseases, called the study the &quot;first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease.&quot;&lt;/p&gt;
&lt;p&gt;According to the authors, the molecular cause of inflammatory bowel disease is largely unknown. But previous animal studies have shown that mice deficient in interleukin-10 or one of its receptors have severe enterocolitis.&lt;/p&gt;
&lt;p&gt;Interleukin-10 restricts excessive immune responses and limits the secretion of proinflammatory cytokines, such as interleukin-12 and tumor necrosis factor-alpha (TNF-alpha), the researchers said.&lt;/p&gt;
&lt;p&gt;So in their study, they examined the families of two unrelated children who have a severe form of Crohn&apos;s disease that occurs in the first year of life. A total of 15 persons were assessed, including siblings.&lt;/p&gt;
&lt;p&gt;Investigators analyzed the genomes of each family, performing gene-specific and protein-specific assays to determine the functional effects of the mutations on interleukin-10 signaling.&lt;/p&gt;
&lt;p&gt;In four of nine patients with early-onset colitis, the researchers found three distinct homozygous mutations in genes IL10RA, IL10RB  --  which encode the IL10R1 and IL10R2 proteins, respectively  --  and ultimately make up the interleukin-10 receptor.&lt;/p&gt;
&lt;p&gt;These mutations abrogate interleukin-10-induced signaling, the researchers said.&lt;/p&gt;
&lt;p&gt;They also found increased secretion of tumor necrosis factor (TNF) alpha and other proinflammatory cytokines in patients deficient in IL10R proteins.&lt;/p&gt;
&lt;p&gt;&quot;We have shown that loss-of-function mutations in either IL10RA or IL10RB can be found in children with severe, early-onset enterocolitis,&quot; they added.&lt;/p&gt;
&lt;p&gt;The findings &quot;are consistent with the idea that a lack of negative-feedback signaling mediated by interleukin-10 perturbs homeostasis of the intestinal immune system.&quot;&lt;/p&gt;
&lt;p&gt;They speculated that in the absence of any interleukin-10 mediated anti-inflammatory response, the presence of intestinal bacteria may lead to activation of a quick immune response, &quot;resulting in a hyperinflammatory response with associated tissue damage.&quot;&lt;/p&gt;
&lt;p&gt;Meanwhile, with conventional therapy unsuccessful in the two young patients, the researchers attempted an allogenic stem-cell transplantation, which was successful.&lt;/p&gt;
&lt;p&gt;Kelsall cautioned, however, that past trials of recombinant interleukin-10 in inflammatory bowel disease patients have been largely disappointing.&lt;/p&gt;
&lt;p&gt;&quot;Although interleukin-10 had an acceptable side-effect profile, systemic treatment with the drug did not prevent the recurrence of Crohn&apos;s disease in patients after surgical resection,&quot; he said, &quot;and induced only modest responses in patients with corticosteroid-refractory Crohn&apos;s disease and in those with mild-to-moderate ulcerative colitis.&quot;&lt;/p&gt;
&lt;p&gt;Kelsall also noted that the mutations identified in the study are rare and recessive, and probably don&apos;t contribute to less severe forms of the disease.&lt;/p&gt;
&lt;p&gt;He did, however, say that the study should &quot;spur new energy to fuel the search for genetic and functional contributions by interleukin-10 and its receptors and their related signaling pathways in understanding the pathogenesis of inflammatory bowel disease and to re-evaluate therapeutic strategies.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the European Commission Marie Curie Excellence Program, the German Federal Ministry of Education and Research, the Intramural Research Program of the National Institutes of Health, and by fellowships from Deutsche Jose Carreras Leukamie-Stiftung and Else-Kroner-Fresenius-Stiftung.&lt;/p&gt;&lt;p&gt;A co-author reported financial relationships with Viamet, Cytokine PharmaSciences, and UCB.&lt;/p&gt;&lt;p&gt;Kelsall reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_27"
                     title="H&lt;sub&gt;2&lt;/sub&gt; Blockers in Preemies Raise Necrotizing Enterocolitis Risk"
                     score="-0.005"
                     href="