Health notes: Brain procedure remarkable, but risky

  • Updated: July 20, 2013 - 5:25 PM
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Dr. Geoffrey Manley held a cranial prosthesis to be fitted in a trauma patient.

Photo: Jim Wilson • New York Times,

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Following the crash of Asiana Airlines Flight 214, one of the first victims rushed to San Francisco General Hospital and Trauma Center was a teenage girl, unconscious and gravely injured.

Her brain was quickly swelling, with nowhere to go but through the small opening at the base of her skull. Such an event, known as “herniation,” crushes the brainstem and can be rapidly fatal.

Unable to reduce the swelling with medications, neurosurgeons decided to remove a large portion of the girl’s skull. Once they had done so, her brain bulged through the opening. The operation relieved the pressure and saved her brain, but it was not enough to save her life. The girl died of the other injuries she suffered in the crash.

The operation, called decompressive craniectomy, is a remarkable but controversial feat, increasingly used to treat victims of head trauma who once might not have been saved. Malala Yousafzai, the 16-year-old Pakistani schoolgirl targeted by the Taliban, and Gabrielle Giffords, the former Democratic congresswoman from Arizona, each underwent decompressive craniectomies after being shot in the head.

The procedure raises difficult questions regarding trade-offs between quantity and quality of life. Despite many successful recoveries, significant numbers of patients who receive the operation die, or are left profoundly disabled. Some are minimally responsive; others have impaired cognitive and motor function.

“What we need to work out better with more trials and research is, ‘Can we predict the patients who will do well with craniectomy and those who won’t?’ ” said Dr. Jeffrey V. Rosenfeld, a neurosurgeon at the Alfred Hospital in Melbourne, Australia. “We have a rough idea, but we still get surprises.”

New York Times

First scan is approved to diagnose ADHD

The Food and Drug Administration has approved the first medical scan that can help diagnose attention deficit hyperactivity disorder in children by measuring brain waves.

The agency said it cleared the NEBA system to help confirm ADHD for people ages 6 to 17. Doctors can use the device to confirm an ADHD diagnosis or to determine if more testing is necessary.

The device, from Augusta, Ga.-based NEBA Health, measures the frequency of two standard brain waves known as theta and beta waves. Children with ADHD tend to have a higher ratio of these waves than children who don’t have the disorder.

The FDA approved the 15- to 20-minute test based on a study of 275 patients. Clinicians evaluated the patients using the system as well as standard diagnostic tools such as like behavioral questionnaires. The study showed that use of the NEBA System helped doctors make a more accurate diagnosis than using traditional methods alone. The American Psychiatric Association states that ADHD affects 3 to 7 percent of school-aged children.

Associated Press

long-term obesity raises heart risk

Young adults who remain obese for two decades or more double their risk of developing a marker of heart disease in middle age, a study found.

Every year of obesity raises the risk of developing coronary artery calcification, a silent predictor of heart disease with mild to no symptoms, by 2 to 4 percent, said research in the Journal of the American Medical Association.

More than one third of U.S. adults ages 20 and older, and 17 percent of children and teenagers, are obese, the U.S. National Institutes of Health said. About $147 billion a year is spent in the U.S. on obesity-related medical costs, according to a 2011 report. The new study is the first to show that how long a person is obese can independently contribute to heart risk, said Jared Reis, the lead study author. “What our study suggests is if we’re measuring only body mass index and waist circumference we may be underestimating the health risks of obesity by not measuring the duration,” said Reis, an epidemiologist at the NIH’s National Heart, Lung, and Blood Institute in Bethesda, Md.

Bloomberg News

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