Pacemaker-like Procedure Helps Painful Nerve Problems
Mayo orthopedic surgeons are using pacemaker technology to help people with severe chronic pain from injured peripheral nerves. In the journal Hand Clinics, Dr. William Cooney reports on Mayo's experience treating patients whose nerves in their wrists and arms have been severely injured, causing them to be supersensitive to pain. He writes that these patients typically have pain "that appears to be the result of overwhelming, uninhibited sensory stimuli that embrace the central nervous system such that even minor perceptions of cold, touch, vibration or moving impulses stimulate a painful experience." Based on the theory that stimulating certain nerve fibers may reduce pain perception, surgeons tried a procedure similar to a pacemaker operation. They implant an electrode under the skin next to the affected nerve. The electrode is connected to a small electrical generator implanted in the patient's flank, which delivers a continuous small electrical impulse to the nerve.
Dr. Cooney says that of the 60 patients who have been followed for at least two years, 80 percent report either complete pain relief after the procedure or sufficient relief that they can sleep at night and be free from addicting narcotic pain medications.
Outcome Study Documents the Effectiveness of Breast Reduction
A group of Mayo Clinic patients report overwhelming satisfaction with the outcome of breast reduction surgery (reduction mammoplasty), according to a study published in a recent issue of Plastic and Reconstructive Surgery. The authors surveyed 363 consecutive patients who had breast reduction at either Mayo Clinic Rochester or Mayo Clinic Scottsdale from 1986 to 1993. Better than 90 percent of patients responded. Of the respondents, 94.2 percent said that the procedure was completely or very successful, and only 1.5 percent believed that it was not very successful or completely unsuccessful.
The symptoms most frequently reported by patients prior to surgery were:
Uncomfortable feeling about their body 97.0 percent
Inability to find clothes that fit 95.7 "
Pain in bra-strap groove 92.4 "
Shoulder pain 86.0 "
Inability to run 79.3 "
Upper back pain 79.0 "
Inability to participate in sports 77.4 "
Neck pain 70.7 "
Lower back pain 64.0 "
Rash under the breasts 61.0 "
These symptoms were either relieved or partially relieved in 88 percent or more of the patients. Of the survey respondents, 97.3 percent said that they definitely or probably would have the procedure again, and only 1.2 percent definitely, or probably, would not have the operation again.
"Breast reduction, if properly performed and with correctly selected patients, can significantly improve a patient's life," says Paul L. Schnur, M.D., chairman of the Division of Plastic and Reconstructive Surgery at Mayo Clinic Scottsdale and primary author of the study.
For information or copies of this article, contact: Kim Van Nimwegen, Mayo Clinic Scottsdale News Bureau, 602-301-3552 (days), 602-301-8000 (evenings), e-mail: [email protected].
Artificial Sphincter Helps People with Urinary Incontinence
Surgical implantation of an artificial sphincter is a very effective treatment for urinary incontinence, say Mayo urologists in a report in World Journal of Urology. The authors looked at Mayo's experience with this treatment in 458 patients (417 men and 41 women) over the past seven years. They found that the continence rate was 88 percent and patient satisfaction rates over 90 percent after the operation. Urinary incontinence has many causes but the most common is injury to the sphincter in the course of prostate surgery. The sphincter is a small muscle outside the bladder that controls the flow of urine. Many people without a sphincter have to rely on diapers and many become "incontinent cripples," avoiding social contact because of fear of embarrassment. The artificial sphincter is a device like a tiny blood pressure cuff which encircles the urethra, the tube coming from the bladder, and keeps it closed. To urinate, the patient squeezes a tiny pump, implanted in the scrotum in men, in the labia in women, which deflates the cuff allowing urine to flow. The cuff then refills automatically from a tiny reservoir. Surgeons reported that reoperations were required in 23 percent of the cases, due to problems such as kinking of the tubing in the device. But the authors say that improvements in the technology have reduced reoperations dramatically in recent years.
Telemedicine Useful for Speech Disorders
The use of telemedicine to evaluate speech and language disorders can be "reliable, beneficial and acceptable to patients," say Mayo speech pathologists. They report on their experience with more than 150 "consultations by satellite" in the November issue of Mayo Clinic Proceedings. The consultations were done using live, two-way video between therapists at Mayo in Rochester and patients at other Mayo locations in Wabasha, Minn., Jacksonville, Fla., and Scottsdale, Ariz. They evaluated a wide range of problems, including loss of the ability to speak, spasm of the voice box and stammering and stuttering. In one example, they examined a 50-year old man with a nine-year history of voice problems, which caused him to feel depressed. He was found to have mild spasms of his voicebox and was treated with injections of botulism toxin, which relieved the spasming and his depression. The authors concluded that the satellite assessments can lead to diagnoses consistent with thos! e obtained with face-to-face interaction. Face-to-face evaluations were found necessary in less than five percent of the cases, they said.
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Contact:
Michael O'Hara
507-284-9522
[email protected]
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