Laparoscopic removal of cystic calculi

Laparoscopic removal of cystic calculi

] New Information about U.S. health care in 1997. Out-of-pocket spending, in billions. $29 $27 Herbs 5.1 Vitamins 3.3 Books 4.7 II | Diet Product...

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New Information about

U.S. health care in 1997. Out-of-pocket spending, in billions. $29 $27 Herbs 5.1 Vitamins 3.3 Books 4.7

II

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Diet Products 1.7

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Professional Services 12.2

Alternative ConventionalHospitaltreatments physician ization services Source: Journal of the American

Medical Association

AMA backs ancient Chinese remedy Alternative medicine therapies were used last year by 40% of all Americans, according to a recent article in the Journal of the American Medical Association (JAMA), an increase of 25% since 1990. Americans now spend nearly as much of their discretionary health care dollars on alternative treatments as on conventional physician services. This does not include costs covered by medicare, HMOs or other health insurance. Over five billion dollars were spent on herbs last year. Some herbal remedies were found to be effective in recent scientific studies. One remedy, in particular, seems to run counter to traditional Western ways of thinking, but has been shown to be effective. According to an Associated Press article by Lauran Neergaaard, "It's an ancient Chinese remedy that many U.S. doctors will find bizarre: heating the herb mugwort next to the little toe of a pregnant woman to help turn her baby out of the risky breech position just before birth." The JAMA article was an attempt to separate the effective therapies from the quackery. The editor, Dr. George Lundberg said, "We are opening the door to what we hope is an important flow of information between different cultures in subjects that matter to people." Regarding the breech baby remedy, Dr. Lundberg said, "the data for this trial is really very good." An explanation for how it works is as follows: "The heat stimulates an acupuncture point on that toe that increases fetal movement, helping the baby move out of breech position." Dr. Francesco Cardini, an Italian obstetrician and acupuncturist, divided 130 women with breech fetuses in two Chinese hospitals into two groups. One got the Ancient Chinese Treatment for 30 minutes a day in late pregnancy, the other got no treatment. After two weeks, ultrasound tests showed 75% of the treated women's babies had shifted out of breech position versus 48% of the untreated. The Associated Press article noted that many doctors are skeptical of any alternative therapy. But, as the JAMA paper described, some alternative therapies work and some don't. Dr. Lundberg said, "There is no 'alternative medicine.' Treatments either work or don't. We are opening the door to what we hope is an important flow of information between different cultures in subjects that matter to people." For the same reasons, this journal published an article on herbs last month, written by Dr. David Ramey. There are inherent dangers in using the remedies that do not work, just as there are benefits in using those that do. In time, with appropriate studies and open communication on the subject, scientists will sort out the good from the bad for a society that seems to want to believe herbs really work.

Laparoscopic removal of cystic calculi A study reported at the 6th Colic Research Symposium describes a technique for laparoscopic removal of cystic calculi in horses. Three geldings, ages 6-9 years, presented to the WSU Veterinary Teaching Hospital for removal of cystic calculi. Each horse was placed under

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JOURNAL OF EQUINE VETERINARY SCIENCE

general anesthesia'and positioned in dorsal recumbency on a table and tilted approximately 30 degrees in a head-down position, A laparoscope portal was placed in the umbilicus. Five instrument portals were placed in positions lateral to the prepuce and base of the penis. The bladder was visualized through the laparoscope and incised using electrocautery. The calculus was retrieved using large grasping forceps and placed in a sterile specimen bag which had been pre-positioned within the abdomen. The bladder was lavaged and sutured in two layers. All instruments were removed and the specimen bag containing the calculus was removed by enlarging the laparoscope portal. Each horse recovered from anesthesia in a large animal recovery pool. All horses regained normal function of the urinary bladder and urinary tract and are currently healthy and showing no signs of urinary dysfunction. This technique permits excellent visualization of the bladder in its normal anatomic position allowing for tension-free manipulation of tissues and a secure closure. Laparoscopic surgery provides an alternative approach for equine surgeons which is less invasive than traditional approaches.

Claude A. Ragle, Dominic A. Carrica, Mark Howlett, Margo M. Mehl. Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164.

Dr. David Ramey on magnets You can strap magnets onto just about any area of the horse, thanks to pads, boots and blankets that have been designed for this purpose. You can buy machines that create a magnetic field that pulses on and off. Magnets have been tried as therapy since at least the 1600s. So far, no one has shown that they do anything. Machines that pulse magnetic fields are approved by the U.S. Food and Drug Association for the treatment of delayed and non-union bone fractures. The pulsing field is able to cause a small electrical voltage in tissue; the effects of the machines are thought to be electrical, not magnetic. Their use in the treatment of fresh fractures, wound and soft tissue healing is the subject of ongoing investigation; the devices may have limited use in these areas. Some studies even show that the machines are detrimental to the healing of fresh fractures. Unfortunately, the principal use of the machines in people (delayed fractures) is not one that appears often in horses. There is no known biologic mechanism by which applying a static magnetic field (one that doesn't change) to tissue could have an effect. Magnetic devices have been advertised for a long time as having all sorts of purported benefits, mostly involving their proposed ability to increase circulation to an area (you could buy magnetic insoles for your boots from the Sears catalog in the 1800s). Blood is good; without blood, tissue dies. One hope with magnets is that by increasing the flow of blood to an area, healing will be promoted. This has never been conclusively demonstrated; one study that was done using magnets suggested an increase in bone activity under magnetic pads applied to the cannon bone, but that study has been roundly criticized in scientific circles. However, even if magnets were to increase circulation to any area, it's never been demonstrated that increasing circulation to an area would decrease the amount of time that it would take to return injured tissue to normal. In fact, increasing circulation to an already inflamed joint would probably not be a good thing.

Volume 18, Number 12, 1998

From Arthritis in the Horse, by David Ramey, DVM, published by Howell Book House/Macmillan

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