2009 Agosto

Patients infected with a particular subtype of HIV, the virus that causes AIDS, are more likely to develop dementia than patients with other subtypes, a study led by Johns Hopkins researchers shows. The finding, reported in the September Clinical Infectious Diseases, is the first to demonstrate that the specific type of HIV has any effect on cognitive impairment, one of the most common complications of uncontrolled HIV infection.

HIV occurs in multiple forms, distinguished by small differences in the virus genetic sequence and designated by letters A through K. Certain subtypes appear to cluster in particular areas of the world, and others have been associated with different rates of progression to full blown AIDS. Of the 35 million people living worldwide with HIV, the majority live in subSaharan Africa, where subtypes A, C and D dominate.

Nearly half of patients with advanced HIV infections have at least mild cognitive impairments, and about 5 percent have the severe form of cognitive impairment known as dementia.

In earlier research, Ned Sacktor, M.D., and his colleagues found that about 31 percent of patients visiting an infectious disease clinic in the Ugandan capital, Kampala, where subtypes A and D dominate, had dementia. The finding led him and his team to wonder whether patients with different subtypes had different rates of dementia.

Sacktor, professor of neurology at the Johns Hopkins University School of Medicine and a clinician at the Johns Hopkins Bayview Medical Center, and his colleagues studied 60 HIVinfected patients from a Kampala clinic. All of the subjects had been part of a different study testing the effect of antiretroviral drugs on cognitive impairment, but had not begun taking the drugs. After determining each patients HIV subtype, they performed a battery of neurological and cognitive tests to assess each patients brain function.

As expected, the majority of the patients had HIV subtypes A or D. Out of the 33 subtype A patients, the researchers determined that seven had dementia, or about 24 percent. However, out of the nine patients with subtype D, 8 had dementia, about 89 percent.

“We were amazed to see such a dramatic difference in dementia frequencies between these two subtypes,” Sacktor says. “If this is the case in all of subSaharan Africa, HIVassociated dementia may be one of the most common, but thus far unrecognized, dementias worldwide.”

The research suggests that some biological property of each subtype seems to influence the likelihood that infected patients will develop dementia, says Sacktor. He and his team hypothesize that subtype D may cause more inflammation and injury in the brain, a possibility they are currently investigating.

As part of its ongoing effort to support bipolar depression awareness and education, AstraZeneca (NYSE AZN) is bringing The Bipolar Journey Living With Bipolar Depression interactive exhibit to patients and caregivers across America. Those who have been touched by bipolar depression the depressive phase of bipolar disorder are encouraged to visit a nearby exhibit site and learn more about living with this disease and how to help manage it.

“The more you understand about bipolar depression, the better equipped you are to cope with your disease or help a loved one do the same,” said Janet Taylor, M.D., a New Yorkbased Psychiatrist in private practice. “In my experience working with patients and families, Ive learned that an engaging, interactive approach can be very effective. The Bipolar Journey exhibits consumerfocused activities provide insight and clarity into the life of a patient living with and managing bipolar depression.”

The Bipolar Journey features imagery, multimedia activities, and interactive tools to help patients connect with experts as well as other patients and caregivers who have dealt with the impact of bipolar depression in their own lives. For example, a unique tool lets visitors select questions that interest them and hear tailored video responses from Dr. Taylor. Through a powerful feature called “My Story,” visitors can step into a photo booth to give a short message of inspiration about their experience with bipolar depression. Select messages are then posted on an “inspiration wall” to travel around the country with the exhibit, inspiring hope in others. Additional features include a podcast listening station and a short video.

One of the main goals of The Bipolar Journey is to give patients the resources they need to help find appropriate support to manage their disease. In addition to encouraging patients to work with a physician to develop a treatment plan, the exhibit offers opportunities to register for Thinking Forward(TM), a support program that provides free information, resources, and practical advice for people with bipolar depression.

Be sure to click on the links to your right to download a tour schedule, examples of featured activities, a fact sheet about bipolar disorder, photos, and additional resources.

About Bipolar Disorder

Approximately 8 million American adults may be affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness.(1,2) Bipolar disorder consists of recurring episodes of mania and depression.(3) Bipolar I disorder is characterized by one or more manic or mixed episodes, often with one or more episodes of major depression, whereas bipolar II disorder is distinguished by one or more major depressive episodes accompanied by at least one hypomanic episode.(3)

Throughout their lives, patients with bipolar I disorder experience depressive symptoms approximately three times longer than manic symptoms.(4) Similarly, patients with bipolar II disorder spend almost forty times longer in the depressed state than in hypomania.(5) Up to 50 percent of patients with bipolar disorder attempt suicide, and approximately 15 to 20 percent complete suicide.(6)

Bipolar disorder is often misdiagnosed as major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease. In fact, many patients face ten years or more before a correct diagnosis is made.(7) Therefore, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.(8)

Bipolar disorder is typically managed through a treatment strategy with several phases including acute and maintenance phases. In the acute phase, the goal is to treat the patient until symptoms remit; the maintenance treatment phase aims to reduce the risk of recurrence of future episodes.(8)

About AstraZeneca

AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of the healthcare services. AstraZeneca is one of the worlds leading pharmaceutical companies with global healthcare sales of $31.6 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $ 13.5 billion dollar healthcare business.

References

1. Hirschfeld RMA, Calabrese JR, Weissman MM, et al. Screening for Bipolar in the Community. J Clin Psychiatry. 2003; 645359.

2. US Bureau of the Census.

3. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC APA; 2000; 382397.

4. Judd LL, Akiskal HS, Schettler PJ, et al. The Longterm Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Arch Gen Psychiatry. 2002; 59530537.

5. Judd LL, Akiskal HS, Schettler PJ, et al. A Prospective Investigation of the Natural History of the Longterm Weekly Symptomatic Status of Bipolar II Disorder. Arch Gen Psychiatry. 2003; 60261269.

6. MA, Chaudhury SR, Mann JJ. Pharmacotherapy of Suicidal Behavior in Bipolar Disorder. Archives of Suicide Research. 2005; 9(3)237250.

7. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and Impact of Bipolar Disorder How Far Have We Really Come? Results of the National Depressive and ManicDepressive Association 2000 Survey of Individuals With Bipolar Disorder. J Clin Psychiatry. 2003; 64161174.

8. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition. April 2002.

“The U.N.s World Food Programme (WFP) appealed on Tuesday for more than $230 million to provide emergency food aid over the next six months for 3.8 million Kenyans affected by deepening drought and high food prices,” Reuters reports (Wallis, 8/25).

The WFP reports that the main maize harvest is projected to be 28 percent below average and that “pasture and water for livestock is dwindling rapidly,” according to VOA News. The agency also says that malnutrition rates are increasing significantly. In some areas, more than 20 percent of people are malnourished, “which is well above the emergency threshold of 15 percent,” VOA News writes (Schlein, 8/25).

Burkard Oberle, WFP Kenya country director, said that at least 260,000 metric tons of food are needed, IRIN reports. WFP is already distributing about 32,000 metric tons of food each month to 2.6 million people (8/25).

VOA News In Kenya, food prices are currently between 100 and 130 percent above normal, according to WFP spokeswoman Emilia Casella. “This is a country where obviously many people are buying the majority of their food and spending the majority of their salaries on food,” she said (8/25).

Reuters “Red lights are flashing across the country,” Oberle said in a statement. “People are already going hungry, malnutrition is preying on more and more young children, cattle are dying we face a huge challenge and are urging the international community to provide us with the resources we need to get the job done,” he said (8/25).

The Associated Press published an article examining how the drought is affecting people in Kenya. “The slums, where roughly half the capitals 4 million residents live, are being hit the worst. Taps have run dry and residents often wait for days for trucks to deliver expensive potable water,” according to the AP (Odula, 8/26).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Venlafaxine and duloxetine alleviate symptoms better than sham drug
The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (GBA) to investigate whether patients with depression benefit from taking drugs belonging to the selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug class. Up till now, 2 of these drugs have been approved as antidepressants in Germany venlafaxine and duloxetine. The Institute published its final report on 18 August. According to this report, the benefit of both drugs has been proven compared to a sham drug (placebo) patients respond better to the therapy and suffer less from the symptoms of depression. Moreover, there are indications that both drugs protect against relapse in addition to alleviating symptoms.

Interplay of biological and psychosocial factors
There are various assumptions about when and how depression occurs. The possible causes and influencing factors are manifold. What is not disputed is that the complete clinical picture of depression is the result of a complex interplay of biological and psychosocial factors. There are indications that a modification or reduction in the transfer of certain messenger substances in the central nervous system plays a part. This is where most drug therapies start their effect. The comparatively new SNRI drug class is intended to influence two of these messenger substances (neurotransmitters) by inhibiting the reuptake of serotonin and norepinephrine.

Manufacturers provide unpublished data
IQWiG and its external experts found a total of 80 clinical trials that could be included in the assessment. Sixteen compared duloxetine (manufacturer Lilly) with a sham drug or another antidepressant, 62 tested venlafaxine (manufacturer Wyeth) in the same way, 2 trials compared the 2 drugs directly with each other. The manufacturers of both the drugs investigated (Lilly and Wyeth) provided a great deal of unpublished data.

In these trials, the effect of the drugs is mostly measured on scales that patients and/or health practitioners can use to document changes in symptoms. IQWiGs benefit assessment included outcomes such as the change in depressive symptoms and accompanying symptoms such as anxiety, pain or sleep disorders, as well as mortality, suicidal tendency, quality of life, daily routine (social functioning level) and adverse drug effects.

Patients respond better to both drugs than to placebo
IQWiG and its external experts came to the conclusion that in acute therapy patients respond better to both drugs than to a sham drug. There is greater alleviation of symptoms, and in some cases they recede to such an extent that some patients no longer fulfil the criteria for a depression diagnosis. As far as relapse prevention is concerned, there is at least an indication that patients benefit more from duloxetine and venlafaxine than from a sham drug. In contrast to duloxetine, there is also proof in the case of venlafaxine that the drug provides more effective protection than placebo against a renewed occurrence of depressive symptoms (recurrence prevention). In the direct comparison of venlafaxine and duloxetine, neither drug displays superiority over the other with regard to alleviating depressive symptoms.

With reference to the healthrelated quality of life, an advantage was proven for duloxetine in the comparison with placebo, but not for venlafaxine. However, if the drugs are compared directly, there is no relevant difference. In the comparison with a sham drug, both drugs also improve the patients ability to manage their daily routine (social functioning level).

Venlafaxine has limited additional benefit compared to other antidepressants
In the comparison with another antidepressant drug class, selective serotonin reuptake inhibitors (SSRI), venlafaxine displays an advantage it alleviates depressive symptoms better than the comparator drugs. However, the same does not apply to duloxetine.

Differences are visible in side effects
The investigation into adverse drug effects revealed that venlafaxine is superior to duloxetine in the direct comparison, as fewer patients discontinued therapy due to side effects. In this context, however, both drugs are inferior to SSRI.

Little influence on accompanying symptoms of depression
With regard to accompanying symptoms of depression, such as anxiety, pain or sleep disorders, there is only one relevant difference revealed in the included trials In the venlafaxine group, patients suffered less from anxiety conditions than in the placebo group. However, no relevant effect could be established for either of the two drugs with regard to the other accompanying symptoms investigated. This applies both to the comparison with a sham drug and the comparison with other antidepressants.

Report preparation procedure
IQWiG published the preliminary results in the form of the preliminary report at the beginning of December 2008 and interested parties were invited to submit comments. When the comments stage ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee, at the end of June 2009. Documentation of the written comments and minutes of the oral debate are published in a separate document simultaneously with the final report. The report was produced in collaboration with external experts.

Source
Dr. AnnaSabine Ernst

A Washington Times editorial claims that President Obama “isnt being straight” with voters when he says the current health care reform proposals in Congress “dont provide government funding for abortion.” The editorial says, “If Democratic plans are passed, your taxes will pay for abortions.” During a conference call with religious leaders last week, Obama said, “Youve heard that this is all going to mean government funding of abortion. Not true.”

The editorial calls this Obamas “most demonstrably false statement.” The editorial cites an Aug. 5 Associated Press article reporting that the Senate version of health reform legislation is “still largely silent on the abortion issue.” The editorial also claims that the House Energy and Commerce Committees version (HB 3200) includes an amendment that “specifically provides for abortion coverage,” the editorial says. According to the editorial, the amendment, sponsored by Rep. Lois Capps (DCalif.), reads “Abortions for Which Public Funding Is Allowed. The services described in this subparagraph are abortions for which the expenditure of federal funds appropriated for the Department of Health and Human Services is permitted … .”

“You cant get more explicit than that,” the Times says. Although the amendment “includes all sorts of other language that provides a thin reed of deniability about the abortioncoverage mandate,” it “absolutely requires that each premium rating area include at least one plan that covers any abortion service and even all those private plans will feature governmentfinanced subsidies,” the editorial states. Obama is “wrong to promote any plan that provides public subsidies for abortion,” the editorial continues, concluding, “No amount of dissembling can cover up the repellent reality of whats in current health care legislation” (Washington Times, 8/24).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

UCSF researchers have identified the two key circuits that control a cells ability to adapt to changes in its environment, a finding that could have applications ranging from diabetes and autoimmune research to targeted drug development for complex diseases.

The new findings are featured as the cover story in the August 21, 2009 issue of the journal Cell and are available online at cell.com.

The limited number of circuits that can achieve adaptation represents a fundamental shift in our understanding of this important biological behavior, which previously had been thought to be affected by hundreds of different circuits, according to Chao Tang, PhD, who was cosenior author on the paper with Wendell Lim, PhD.

Both Lim and Tang are faculty members in the UCSF departments of Bioengineering and Therapeutic Sciences and of Biochemistry and Biophysics, and are affiliated with the California Institute for Quantitative Biosciences (QB3) at UCSF.

Adaptation is a fundamental property of many cellular sensing systems, allowing the cell to automatically reset itself after responding to a stimulus, Lim said. These adaptive circuits are what enable eyes to adjust to changes in light, white blood cells to move toward bacteria, or insulin levels to adjust to sugar loads. They are involved in heat adaptation, movement, sight and smell, among others. They also are often the mechanisms that go wrong at a molecular level in some of the most difficult diseases to treat.

“Many diseases are diseases of homeostasis,” explained Lim, who is also affiliated with the Howard Hughes Medical Institute. “Diabetes or autoimmune diseases, for example, are based on a disruption in the circuitry that prevents the body from readjusting itself.”

Until now, however, the millions of circuits involved in that adaptive response were impenetrably complex.

For this research, the team used a computational method to analyze 160 million circuits that come into play when a cell adapts to environmental stimuli and monitored them for the circuits sensitivity to a stimulus and the precision of its adaptation.

The result was an exhaustive circuitfunction map of enzymatic regulatory networks that identified two core structures that are common to every adaptive response, however simple or complex a negative feedback loop with a buffering node, and a feedforward loop that adjusts the proportion of response. Furthermore, the researchers said, they established that the most robust adaptive responses rely heavily on at least one of these two minimal motifs.

“This is a new way of looking at biology and disease,” Lim said. “Weve sequenced the genome, we know the genes involved and have started to understand how theyre connected together. But its like opening your computer and looking at the chips and circuits inside how do you begin to understand it?”

Unlike chemistry, in which the core elements were understood 100 years ago, there is no equivalent of the periodic table in the field of biology. The field of systems biology, in which both Lim and Tang focus, aims to create that same systematic approach to understanding how cells and biological systems work.

The goal is to break down the overwhelming amount of information that has been generated by advances over the last decade in genetic sequencing, into recognizable modules that can then be further studied, understood and ultimately used to create drug therapies for complex diseases such as cancer and diabetes that involve multiple genes.

Thus, beyond the specific advance in this particular research, the teams ability to reduce millions of cellular responses to two common circuits lays the groundwork for similar analyses in other biological systems. Despite the diversity of possible biochemical networks, the team said, it may be common to find that only a finite set of core structures can execute a particular function.

“From a scientific standpoint, this is about one thing Are there universal principles in biology, and if so, what are they,” Tang said.

The potential applications from these studies could be tremendous in medicine, an understanding of what causes a system to shift from one behavior to another could greatly aid in developing more targeted therapeutics for treatments of complex diseases like cancer, the researchers said.

Fundamentally, the complex network of homeostatic response is what makes these diseases so difficult to tackle therapeutically, according to the research team. If the entire network is out of balance, a drug that blocks a single receptor wont work. Identifying the core structures behind adaptive response, however, makes it possible to someday create a therapy that could readjust that network.

It also could have applications in the emerging field of synthetic biology, by serving as a manual for how to engineer robust biological circuits that carry out a target function.

The lead investigator on the paper was Wenzhe Ma, a visiting scholar in the Tang lab from the Center for Theoretical Biology, Peking University, Beijing, China. Coauthors were Ala Trusina, from the UCSF Department of Bioengineering and Therapeutic Sciences, and Hana ElSamad, with the UCSF Department of Biochemistry and Biophysics. Both Lim and Tang have joint appointments in the UCSF Department of Bioengineering and Therapeutic Sciences, in the School of Pharmacy, and in the School of Medicines Department of Biochemistry and Biophysics. Lim is also a member of the Department of Cellular and Molecular Pharmacology, and the Howard Hughes Medicial Institute. All coauthors on the paper are affiliated with the California Institute for Quantitative Biosciences (QB3) at UCSF.

Support for Tangs research came through grants from the Li Foundation, Sandler Family Supporting Foundation, National Science Foundation, Ministry of Science and Technology of China, and National Natural Science Foundation of China. Lim also received support from the Howard Hughes Medical Institute, the Packard Foundation and the NIH Nanomedicine Development Centers. The authors report no conflicts of interest on this research.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduatelevel education in the life sciences and health professions, and excellence in patient care.

Source
Kristen Bole

The NPA has produced a guide to setting up a community pharmacy vascular risk assessment service and a Standard Operating Procedure (SOP) for vascular risk assessment.

The NPA SOP “Vascular Risk Assessment” covers the measurement and assessment of cardiovascular risk factors in adults without previously diagnosed diabetes, existing cardiovascular disease (CVD), or lipid disorders. The “NPA guide to setting up a Community Pharmacy Vascular Risk Assessment Service” provides information on all aspects of a vascular risk assessment service, these include

Staff
Premises
Equipment
Evaluation and audit
Record Keeping
Confidentiality
Clinical governance
Health and safety
Waste
Communication
Marketing

The guide also includes a template letter to GPs and other local providers to let them know about the community pharmacy service.

Sarah Davies, NPA Information Pharmacist said “Vascular diseases are the main cause of death, ill health and disability in the UK. One in every four men and one in every six women in the UK die from CVD and very year about 300,000 people have a heart attack. It is therefore right that community pharmacy is involved in improving patients health to prevent vascular disease. These two NPA resources will help our members develop and put into practice a community pharmacy vascular risk assessment service.”

Oklahoma state officials on Wednesday announced that they plan to appeal a ruling issued Tuesday by Oklahoma County District Judge Vicki Robertson that struck down a state law (SB 1878) imposing numerous abortionrelated restrictions, including a requirement that doctors perform ultrasounds and provide women with detailed information about the image before performing abortions, the New York Times reports.

Robertson ruled that the bill, which included four other abortionrelated measures, violated a clause in the state constitution that requires bills to address only one subject. Robertson did not rule on whether the law violated privacy protections or freespeech rights. State lawmakers passed the law in 2008 over the veto of Gov. Brad Henry (D), but the law never went into effect because of the legal challenge.

Charlie Price, a spokesperson for Oklahoma Attorney General W.A. Drew Edmondson, said that an appeal will be filed with the state Supreme Court. He added that the state will argue that the law does not violate the singlesubject rule because all its parts pertain to abortion. Republican state lawmakers said that if Oklahoma does not win the appeal, they would split the law into five bills and pass them during the next legislative session, which begins in February.

Abortionrights advocates celebrated Robertsons ruling but said that the fight against the law, one of the strictest nationwide, likely will continue for months in the state Legislature and state Supreme Court, the Times reports. “It is one battle in the war, but the war shall continue,” Martha Hardwick, a lawyer with the Center for Reproductive Rights, said. Anita Freeman, head of Planned Parenthood of Central Oklahoma, said that the law intruded on the decisionmaking process between a woman and her doctor. “Even if you dont look at the picture, you have to listen to the description,” she said, adding, “It almost reaches the stage of seeming cruel to me.”

The law would have required providers to set up the ultrasound monitor where the woman could see it and describe the fetus in detail. The law said that the woman would be allowed to “avert her eyes.” In the early stages of pregnancy, the law would have required the ultrasound to be performed vaginally to get a clear image, according to providers. It also did not make exceptions for rape or incest (McKinley, New York Times, 8/19). Other provisions in the law would have required doctors to follow FDA labeling when administering medical abortion drugs. It also would have required signs in clinics telling women that they cannot be coerced into abortions, as well as refusal rights for employees who oppose abortion. In addition, the law would have prohibited wrongful life lawsuits in certain circumstances Daily Womens Health Policy Report, 8/19).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

The American Pharmacists Association (APhA) applauds the efforts of LegitScript and KnujOn to bring attention to the threat posed to patient safety by sponsored search engine results for rogue Internet pharmacies appearing on the nations top Internet search engines. In a coauthored report entitled “Analysis of Yahoo! Prescription Drug Sponsored Search Results,” released on August 18, 2009, the companies examine the Web sites selling prescription medications that advertise through Yahoo!s online advertising program.

Earlier this year, APhA expressed similar concerns for patient safety in letters to Microsoft MSN, Google and Yahoo! for returning sponsored search results for Internet drug sellers that appeared to be operating in violation of law and/or accepted standards of pharmacy practice in the United States.

“Allowing the posting of sponsored search results of Internet drug sellers that dispense prescription medications without a valid prescription supports practices that are contrary to U.S. law, are deceptive to American consumers who are relying on your site to provide them access to legitimate Web sites, and most importantly may be unsafe to U.S. consumers who are relying on these medications to manage their health care needs,” said APhA Executive Vice President and CEO Thomas Menighan.

APhA encourages Yahoo! and other search engines to revise their current policies and standards for prescription drug Web site sponsored search results to, at a minimum, limit postings to Internet sites that are legitimate and comply with U.S. law.

Source

A minimally invasive technique to remove fibroids from womens wombs is being pioneered at a Bristol hospital.

Surgical removal of fibroids, when it is required is commonly carried out through an operation called myomectomy which can involve a large, abdominal cut which can take days for the patient to recover from.

But Valentine Akande, Consultant Surgeon at Spire Bristol Hospital, The Glen, can perform the same procedure but by using minimally invasive keyhole surgical techniques.

“Fibroids are quite common growths found in womens reproductive organs,” he explained. “Although they are noncancerous they can grow quite large, sometimes to the size of a melon, and in extreme cases can cause heavy bleeding, miscarriages and even infertility.”

Mr Akande has been carrying out myomectomies for several years and, as an advanced laparoscopic surgeon, is able to combine the procedures and offer a minimallyinvasive operation.

He said “Women who want to preserve their fertility are advised to have the fibroids removed through myomectomy, but they can be discouraged when they learn the operation is generally carried out by making a large incision through their abdomen.

“Now it is possible to perform the same surgery for suitable patients through laparoscopic techniques, better known as keyhole surgery, using very small incisions to the abdomen, offering quicker recovery times, with most patients going home a day after the surgery, as opposed to several days after the larger open incision.”

It is estimated that between 50 per cent of women will develop fibroids by the age of 50 but only a fifth will experience symptoms and for many, treatment may not be required. For those women who do have surgery it is also estimated that following myomectomy, the chances of pregnancy could be significantly improved.

Mr Akande added “The main message is that women diagnosed with fibroids should not worry too much because it is quite a common condition and, thankfully, is treatable.

“However, no one likes the thought of having a large slice in their stomach, so this minimally invasive technique will, Im sure, come as a welcome to relief to the many women diagnosed with the condition.”

References

Akande VA, Jenkins JM. Surgical versus medical treatment of fibroids. Advances in Obstetrics and Gynaecology (2000) 18, 714.

Pritts EA, Parker WH , Olive DL. Fibroids and infertility an updated systematic review of the evidence. Fertil Steril. 2009 Apr;91(4)121523.