Surgery News - February 2009 - (Page 19) FEBRUARY 2009 • SURGERY NEWS GENERAL SURGERY Large Scanners Lacking for Obese Patients B Y M I C H E L E G. S U L L I VA N Else vier Global Medical Ne ws M orbidly obese patients who need emergency imaging are probably out of luck in much of the United States, because most hospitals don’t have the necessary equipment, and zoos and veterinary hospitals with largecapacity scanners won’t accept human patients. Only 10% of 396 hospitals surveyed were able to image patients weighing 450 pounds or more, and 90% of the hospitals designated as bariatric surgery centers of excellence lacked the super-sized scanners, according to Dr. Adit A. Ginde and colleagues. The lack of large-sized scanners in bariatric surgery centers is “of particular concern, given that the number of gastric bypass surgeries performed in the United States has increased from 67,000 in 2002 to 140,000 in 2005, and that up to one-third of patients undergoing gastric bypass surgery will require an emergency department visit in the postoperative period,” wrote the investigators (Obesity 2008;16:2549-51). Indeed, they suggested that some surgeons might not even consider bariatric surgery for patients who exceed the weight capacity on available imaging equipment. Dr. Ginde, an emergency physician at the University of Colorado Denver School of Medicine, Aurora, and his coauthors surveyed 5% of U.S hospitals with emergency departments, all primary affiliate hospitals of U.S. academic emergency departments, and all the country’s zoos and veterinary schools. Respondents at the hospitals included radiology technicians, department supervisors, and physicians. They were asked about the weight limits on their computed tomography and magnetic resonance imaging equipment. At animal facilities, veterinary personnel were asked the same question, as well as whether they had ever imaged human patients, would consider doing so, or had polices about it. Dr. Ginde and his team collected responses from 396 hospitals, 136 zoos, and 28 veterinary schools. Only 10% of the hospitals designated as bariatric surgery centers of excellence had high-weight CT scanners. Similarly, high-capacity scanners were available in just 3% of critical-access hospitals, 5% of rural hospitals, 26% of stroke centers, and 34% of trauma centers. Academic centers were more likely than were nonacademic centers to have the large scanners (28% vs 10%), whereas 8% of both academic and nonacademic centers had large MRI scanners, the researchers found. Only two zoos had large animal CT scanners, and neither would accept human patients. Veterinary schools appeared to be somewhat more accommodating of human patients. More than half of the schools (57%) had big scan- ners, but only four institutions said they would consider imaging a human. The majority (82%) had formal policies against it. The inability to image obese patients is a serious problem, the authors said. “CT or MRI imaging was required for 11% of all emergency department visits in 2005 and is the standard of care of ED evaluation for many acute medical conditions. Almost all emergency departments—at least 90%—would not be able to obtain CT or MRI imaging studies for patients weighing more than 450 pounds.” Personal communications with some respondents at animal facilities confirmed the need for large scanners for humans: “Informally, many animal facilities reported that they receive regular phone calls regarding their capacity and willingness to image human patients, despite efforts to correct the misconception that this practice is usually permitted.” INDEX OF ADVERTISERS Adolor Corporation Entereg Elan Pharmaceuticals, Inc. Azactam General Scientific Corporation Corporate Wyeth Pharmaceuticals Inc. Tygacil 10-12 5-6 7 19-20 TYGACIL® (tigecycline) Brief Summary See package insert for full Prescribing Information. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556. CONTRAINDICATIONS TYGACIL is contraindicated for use in patients who have known hypersensitivity to tigecycline. WARNINGS Anaphylaxis/anaphylactoid reactions have been reported with nearly all antibacterial agents, including tigecycline, and may be life-threatening. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. TYGACIL should be administered with caution in patients with known hypersensitivity to tetracycline class antibiotics. TYGACIL may cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant while taking tigecycline, the patient should be apprised of the potential hazard to the fetus. Results of animal studies indicate that tigecycline crosses the placenta and is found in fetal tissues. Decreased fetal weights in rats and rabbits (with associated delays in ossification) and fetal loss in rabbits have been observed with tigecycline. (See PRECAUTIONS, Pregnancy.) The use of TYGACIL during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). Results of studies in rats with TYGACIL have shown bone discoloration. TYGACIL should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including TYGACIL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. PRECAUTIONS General Caution should be exercised when considering TYGACIL monotherapy in patients with complicated intra-abdominal infections (cIAI) secondary to clinically apparent intestinal perforation. (See ADVERSE REACTIONS.) In Phase 3 cIAI studies (n=1642), 6 patients treated with TYGACIL and 2 patients treated with imipenem/cilastatin presented with intestinal perforations and developed sepsis/septic shock. The 6 patients treated with TYGACIL had higher APACHE II scores (median = 13) vs the 2 patients treated with imipenem/cilastatin (APACHE II scores = 4 and 6). Due to differences in baseline APACHE II scores between treatment groups and small overall numbers, the relationship of this outcome to treatment cannot be established. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. Such effects may include: photosensitivity, pseudotumor cerebri, and anti-anabolic action (which has led to increased BUN, azotemia, acidosis, and hyperphosphatemia). As with tetracyclines, pancreatitis has been reported with the use of TYGACIL. The safety and efficacy of TYGACIL in patients with hospital acquired pneumonia have not been established. In a study of patients with hospital acquired pneumonia, patients were randomized to receive TYGACIL (100 mg initially, then 50 mg every 12 hours) or a comparator. In addition, patients were allowed to receive specified adjunctive therapies. The sub-group of patients with ventilator-associated pneumonia who received TYGACIL had lower cure rates (47.9% versus 70.1% for the clinically evaluable population) and greater mortality (25/131 [19.1%] versus 15/122 [12.3%]) than the comparator. As with other antibacterial drugs, use of TYGACIL may result in overgrowth of non-susceptible organisms, including fungi. Patients should be carefully monitored during therapy. If superinfection occurs, appropriate measures should be taken. Prescribing TYGACIL in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Information for Patients Patients should be counseled that antibacterial drugs including TYGACIL should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When TYGACIL is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by TYGACIL or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible. Drug Interactions Prothrombin time or other suitable anticoagulation test should be monitored if tigecycline is administered with warfarin. (See CLINICAL PHARMACOLOGY, Drug-drug Interactions in full prescribing information.) Concurrent use of antiba http://www.wyeth.com http://www.wyeth.com
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
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