This undated X-ray image provided by the BMJ in August 2019 shows dentures stuck in the throat of a 72-year-old patient. They became lodged in his throat during surgery and weren’t discovered until eight days later. (BMJ via AP)
Here’s why it’s best to remove false teeth before surgery: You just might swallow them.
A medical journal is reporting the case of a 72-year-old British man whose partial dentures apparently got stuck in his throat during surgery and weren’t discovered for eight days.
The man went to the emergency room because he was having a hard time swallowing and was coughing up blood. Doctors ordered a chest X-ray, diagnosed him with pneumonia and sent him home with antibiotics and steroids. It took another hospital visit before another X-ray revealed the problem: His dentures — a metal roof plate and three false teeth — lodged at the top of this throat.
The man thought his dentures were lost while he was in the hospital for minor surgery.How it happened isn’t exactly clear, but a half-dozen previous cases have been documented of dentures going astray as surgical patients were put to sleep.
Placing a tube in a patient’s airway can push things where they don’t belong, said Dr. Mary Dale Peterson, an anesthesiologist at Driscoll Children’s Hospital in Corpus Christi, Texas.
Besides dentures, retainers, loose teeth and tongue piercings can cause problems, said Peterson, who is president-elect of the American Society of Anesthesiologists. Before a child’s surgery, she’ll pull a very loose tooth and tell the patient to expect a visit from the tooth fairy. “We can make a nice game of it.”
In the British case, after the dentures were removed, the man had several bouts of bleeding that required more surgery before he recovered. The journal article didn’t identify the man or the hospital involved.
What can be learned from this case? Doctors need to listen carefully to their patients and build a timeline of what happened rather than relying heavily on scans and tests, said Dr. Rui Amaral Mendes, an associate editor of BMJ Case Reports, which published the paper Monday.
For their part, patients should tell their doctors about mouth problems before surgery, said Mendes, an oral surgeon at Case Western Reserve University in Cleveland. That includes dentures, blisters and serious gum disease. Loose teeth could be knocked down the throat when tubes are put into the airway.
“Stay on the safe side,” he said. “Inform your physician of what’s going on in your mouth.”
Doctors have gotten much better at detecting and treating breast cancer early. Drug and chemotherapy regimens to control tumors have gotten so effective, in fact, that in some cases, surgery is no longer necessary. In up to 30% of cases of early-stage breast cancer treated before surgery, doctors can’t find evidence of cancer cells in postoperative biopsies. The problem, however, is that there is currently no reliable way to tell which cancers have been pushed into remission and which ones have not.
That’s where an easy identifier, like a blood test, could transform the way early stage breast cancer is treated. In a paper published in Science Translational Medicine, researchers led by a team at the Translational Genomics Institute (TGen), an Arizona-based nonprofit, report encouraging results on just such a liquid biopsy. Its test, called Targeted Digital Sequencing (or TARDIS), was up to 100 times more sensitive than other similar liquid-biopsy tests in picking up DNA shed by breast cancer cells into the blood.
Currently available ways of tracking breast cancer cells in the blood are most useful in people with advanced cancer. In those conditions, cancer cells litter the blood with fragments of their DNA as they circulate throughout the body to seed new tumors in other tissues like the bone, liver and brain. But in early-stage breast cancer, these cells are, by definition, scarcer.
To address the problem, the research team, which included scientists at Arizona State University, the City of Hope, Mayo Clinic, and the Cancer Research UK Cambridge Institute, developed a new way to pick up elusive cancer DNA. They genetically sequenced tumor biopsy tissue from 33 women with stage 1, 2, or 3 breast cancer, most of whom received drug or chemotherapy treatment prior to getting surgery to remove their tumors. By comparing the tumor sequence to the sequence from the patients’ normal cells, the scientists isolated potential mutations that distinguished the cancer cells and identified those that were most likely to be so-called “founder mutations”—genetic aberrations present in the original cancer cells and carried into the resulting tumor.
On average, each patient harbored about 66 such founder mutations. For each patient, the scientists combined the founder mutations to form a personalized assay, which could then be used to pick up signs of breast cancer DNA in blood samples. Combining a number of mutations together turned out to be a more sensitive way to detect tumor DNA than trying to pick up a single or a small number of mutations in an already small number of tumor DNA fragments present in the blood.
They combined this approach with a new strategy for amplifying the scarce tumor DNA found in a blood sample by preserving the size of these snippets and attaching unique molecular identifiers to them to make them more easily detectable.
At the start of the study, TARDIS was able to find tumor DNA in the blood samples of all the patients; other liquid biopsies for breast cancer currently in development have reported picking up 50% to 75% of the cancer cases.
After the pre-surgery treatment TARDIS detected circulating tumor DNA in the blood in concentrations as low as 0.003%, or 100-fold more sensitive than other tests being developed.
“This is an important advance,” says Dr. Debu Tripathy, professor and chair of the breast medical oncology department at the University of Texas MD Anderson Cancer Center, who was not involved in the study. “This test can help identify those with early stage breast cancer who may still have residual cancer in their body that may not be detectable with standard scans.”
That could help guide treatment, by, for example, determining which patients require closer monitoring for recurrent growths. Because the sequencing identifies the genetic mutations contributing to the tumor, the test could also help doctors to decide which targeted drug therapies, which are designed to address specific cancer mutations, to prescribe for their patients.
Most importantly, the test could help women whose tumors are effectively eliminated by their pre-surgery treatment to avoid an operation altogether since the blood test would reassure her and her doctor that no residual tumor DNA remained.
“If we could really know with a more accurate degree of certainty that you don’t have residual disease, it would be help in saying that you don’t need any more therapy [including surgery],” says Dorraya El-Ashry, chief scientific officer of the Breast Cancer Research Foundation. ”Conversely, if you still had residual disease, if there is information from the test that can pinpoint the next therapy, that would also be better.”
Muhammed Murtaza, co-director of the center for non-invasive diagnostics at TGen, says TARDIS needs to be tested in a larger group of breast cancer patients before it can be rolled out to doctors’ offices. His team is planning to study the test’s efficacy in about 200 breast cancer patients, in order to clarify exactly what levels of tumor DNA found in the blood are most likely to lead to recurrence. They are also exploring how modified versions of TARDIS could be applied to other cancers, like esophageal, colorectal, pancreatic and prostate.
There’s even encouraging precedent for this sort of a liquid biopsy. Doctors routinely rely on a blood test for chronic myeloid leukemia, for example, to track patients’ response to targeted drugs that treat specific mutations driving the cancer. “Applying this same technology to more common solid cancers like breast cancer is the new frontier,” says Tripathy.
Caffeine can be both a treatment and a trigger for migraine headaches, which makes it difficult for sufferers to know how much to sip. Experts believe caffeine helps block adenosine, a molecule involved in migraine attacks, from binding to receptors in the brain, so many people use it as an at-home remedy; it’s also an ingredient in many over-the-counter migraine drugs. But, counter intuitively, some migraine sufferers also say consuming caffeine can bring on their debilitating headaches.
“The complex thing with caffeine is sometimes it’s harmful and sometime it’s beneficial,” says Elizabeth Mostofsky, a cardiovascular epidemiology researcher at Beth Israel Deaconess Medical Center in Boston. “It really amounts to the dose and the frequency of having it.”
Mostofsky is a co-author on a new study published in the American Journal of Medicine that helps define that risk-benefit balance. The findings suggest that having three servings of caffeinated beverages such as coffee, tea and soda in a day seems to be the tipping point at which caffeine becomes a possible migraine trigger. (A serving is typically defined as eight ounces of coffee, six ounces of tea, 12 ounces of soda or two ounces of an energy drink. While caffeine content can vary from drink to drink, the study did not distinguish between types of caffeinated beverages.)
For the study, researchers asked 98 adults who suffered two to 15 migraines per month to log their caffeine consumption twice a day for six weeks, along with information about other possible migraine triggers including exercise, alcohol consumption, mood, sleep, menstrual status and weather changes. They also provided information about the symptoms of migraines they suffered during the study period, and how they treated them. Participants also provided their demographic and medical histories. Most of them, like most U.S. migraine sufferers, were female.
After adjusting for other potential triggers, the researchers noticed an inflection point around three servings of caffeine per day. One or two caffeinated beverages per day wasn’t statistically associated with a higher chance of migraine, but downing three or more was linked to a higher risk of headaches both on that day and the one following, the researchers found.
The fact that the correlation applied to the day after high-caffeine consumption is especially telling: Many migraine sufferers use caffeine as a treatment for existing headaches, but the fact that people were more likely to have headaches the day after heavy caffeine consumption suggests that the drinks were causing, not treating, migraines, Mostofsky says.
Mostofsky notes that an individual’s tolerance to caffeine, which can build over time, likely matters too. For example, in this study, people who said they typically had less than one serving of caffeine per day saw a higher risk of migraine on days that they drank even one or two caffeinated beverages. The reverse may be true, too. Plenty of evidence shows that people who are heavy caffeine users can experience headaches, migraine or otherwise, if they miss their daily dose.
The study did not look at which types of caffeinated beverages were most strongly associated with headaches. And since the study was observational, meaning it looked only at patterns reflected in the data, Mostofsky says she can’t prescribe the perfect amount of caffeine. Nonetheless, she says migraine sufferers should keep these findings in mind the next time they’re at the coffee-shop counter.
As the story goes, nearly 80 years ago on the Faroe Islands — a stark North Atlantic archipelago 200 miles off the coast of Scotland — a neurologic epidemic may have washed, or rather convoyed, ashore. Before 1940 the incidence of multiple sclerosis on the Faroes was near, if not actually, zero, according to the tantalizing lore I recall from medical school. Yet in the years following British occupation of the islands during World War II, the rate of MS rose dramatically, leading many researchers to assume the outbreak was caused by some unknown germ transmitted by the foreign soldiers……..
On a sunny afternoon in May, 2015, I joined a dozen other surgeons at a downtown Boston office building to begin sixteen hours of mandatory computer training. We sat in three rows, each of us parked behind a desktop computer. In one month, our daily routines would come to depend upon mastery of Epic, the new medical software system on the screens in front of us. The upgrade from our home-built software would cost the hospital system where we worked, Partners HealthCare, a staggering $1.6 billion, but it aimed to keep us technologically up to date……..
The oncoming flu season has claimed its first lives, among them a child in Florida who had not gotten a flu shot. This year’s vaccine significantly reduces the odds of getting sick — and you should get one now if you haven’t already — but it’s far from perfect. For one thing, its effectiveness fluctuates from year to year. At best, the vaccine may reduce the risk of illness by about 60 percent. Last year, during one of the worst flu epidemics in recent memory, that figure was just 40 percent……..
Most of what we do — the websites we visit, the places we go, the TV shows we watch, the products we buy — has become fair game for advertisers. Now, thanks to internet-connected devices in the home like smart thermometers, ads we see may be determined by something even more personal: our health. This flu season, Clorox paid to license information from Kinsa, a tech start-up that sells internet-connected thermometers that are a far cry from the kind once made with mercury and glass……
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Halfway up a hill overlooking the Great Rift Valley in western Kenya are two graves. One of them is a few years old now, bristling with bushy shrubs stretching bright green leaves towards a cloudless sky. The other is a freshly dug bed of rough red dirt planted with a white wooden cross. They are the final resting places of Emily’s mother and father, who died within four years of each other. Still a young woman, Emily now looks after her family’s rural homestead near Iten – a town famed for churning out long-distance runners and playing host to Mo Farah’s training camps.
Babies are born with a deficiency in vitamin K, an important factor for proper blood clotting. So most newborns are given a shot of vitamin K soon after birth to prevent potentially life-threatening hemorrhages in the brain or intestines. It’s been standard practice since the early 1960s, but the rise in anti-vaccination rhetoric has also created a distrust around the vitamin K shot. And it’s all too easy to find risky or just plain false information. Search “vitamin K shot” on Google and some of the top results caution against them…..
