A Croatian study recently assessed the value of acupuncture in the conversion of fetal breech presentation into vertex presentation. 34 women with singleton pregnancies were treated with manual acupuncture (urinary bladder 67, Zhiyin) twice a week for 30 minutes from the 34th week of pregnancy onwards. Acupoints were identified by anatomic palpation according to their classic description, and an average of six acupuncture sessions was used.

The success rate for spontaneous conversion of breech presentation to vertex presentation for the group of women that underwent acupuncture treatment was 76.4%, compared to only 45.4% of the control group, 33 women with singleton pregnancies not treated with acupuncture. In addition, the rate of fetal movements seemed to increase for the acupuncture group. No complications were observed during or after the procedure. On the contrary, more cesarean sections were performed in the control group (48.4% compared to 35.2%), and good perinatal outcome was recorded in fewer cases (78.7% compared to 91.1%).

As the authors point out, in the context of the current body of literature on this topic, their study confirms earlier findings that have determined acupuncture as a simple, effective and inexpensive method for correcting fetal malpresentations. An approach that is also associated with a lower percentage of operatively completed deliveries, reflecting in improved parameters of vital and perinatal statistics of the newborn.

For the full study, please check Fetal Diagnosis and Therapy, Vol. 18, No. 6, 2003, p.418-421.

A forthcoming Thieme book is devoted to the benefits of acupuncture in obstetrics and gynecology: Roemer, Medical Acupuncture in Pregnancy

(All illustrations taken from Medical Acupuncture in Pregnancy © Thieme 2005)

Thieme congratulates Dr. Goodrich and Dr. Staffenberg on being honored with the Mayor's Awards for Excellence in Science and Technology!

In addition to honoring some of New York's most gifted scientists on Wednesday, Oct. 20, 2004, Mayor Michael R. Bloomberg initiated a unique special award for the surgical team at Montefiore Medical Center for making history with the series of operations to separate the Aguirre twins.

During the presentation at City Hall, Mayor Bloomberg gave the award to Dr. James Goodrich and Dr. Staffenberg, as the leaders of the Children's Hospital at Montefiore team, and Dr. Spencer Foreman, the president of the Montefiore Medical Center. "The eyes of the world were on the Bronx this year as the hospital prepared for an intricate and dangerous surgery," said Bloomberg.

Background:
Pediatric neurosurgeon James Tait Goodrich, MD, and pediatric plastic surgeon David Staffenberg, MD (authors of Thieme's Plastic Techniques in Neurosurgery, 2nd edition), the boys' two lead surgeons, separated the Aguirre twins, together with their 16-member surgical team, in a fourth and final 17-hour operation on Tuesday, August 3, 2004 at The Children's Hospital at Montefiore (CHAM) in New York.

In this final one in a series of operations leading to the separation of the twins over the past 10 months, the tightly abutting brains had to be slowly teased apart before reconstructing the dura mater, the sac of tissue that lines the brain, for each boy individually, using an artificial tissue derived from pig intestine. The missing part of the boys' skulls, where they were conjoined, will be reconstructed in several operations over the course of the following months.

Closely watched by both lead surgeons, the twins are recovering well. "The boys are continuing their habit of rapid recovery from surgeries at CHAM," marveled Dr. David Staffenberg. "We are completely stunned with their activity levels," said Dr. Goodrich, but cautioned that the next few weeks are critical in determining if the surgery will be a long-term success. "Where the boys will be in five years, I just don’t know," he said.

Separting two conjoined brains is a unique surgical experience, something that most neurosurgeons will not likely experience during their careers. An overwhelmed Dr. Goodrich descibed the procedure: "It was awesome, I have to say. I certainly, obviously, had not had that experience before. There were probably a couple [of tears] if you looked close. It was emotional. No two ways about it."

This is the first operation in New York to separate conjoined twins, and will be the first in the world and a major medical and surgical breakthrough, if it allows both twins to develop normally into healthy and happy children and adults.

In an earlier interview with Thieme, Dr. Goodrich talked about the enormous difficulties of the operations, what it takes to be a neurosurgeon, and his life-long passions. Click here for the full interview*.

Read more about the twins on The Children's Hospital at Montefiore website.
(Photos: Montefiore Medical Center/Alice Attie)

Click here for more information and to order:
Goodrich/Staffenberg:
Plastic Techniques in Neurosurgery, 2nd edition



Keating/Goodrich/Packer:
Tumors of the Pediatric Central Nervous System

and other Thieme neurosurgery titles

(* Pdf file, Adobe® Acrobat® Reader required. Free Download.)

According to the latest WHO estimate (2001), 250 million people worldwide suffer from a disabling hearing impairment. In the U.S. alone, an estimated 28 million people suffer from hearing loss. Communication disorders affect and impair a person's development in many ways: cognitive and speech-language development, language acquisition (especially children), and their performance at school and the work place, which can lead to economic difficulties, as well as social isolation and stigmatization.

"May is Better Speech and Hearing Month" has been promoting a better understanding of the options available for those suffering from communication disorders since 1972. Initiated by the American Speech-Hearing Association (ASHA), it has been dedicated to raising awareness of the fields of audiology and speech-language pathology.

Because hearing, speech, and language play such a key role in human life, the field of audiology and speech-language patholgy deals with various influences and patients of all ages. A look at some of the current topics reveals how multi-faceted it is: newborn hearing screening, motor speech disorders in children, auditory and motor speech disorders in school children, otoacoustic emissions, hearing aids, voice disorders, and geriatric audiology.

To learn more about any of these topics, please refer to our audiology and speech-language books and journals.

To find out more about "May is Better Hearing and Speech Month", please visit the ASHA website.

No doubt, laughter and humor are important parts of human life. Without them, our psychological well-being would be in danger and our social lives might be non-existent. But how important is humor for affective, cognitive, and motor networks involved in humor processing? This question was among the ones posed by a team of researchers at the University of Stanford, CA.

The goal of their study was to demonstrate that humor modulates activity in several cortical regions and engages a network of subcortial regions, including humor-reward, which had not been proven scientifically before.

The team around Allan Reiss gathered 16 volunteers who were presented with a neutral and a funny cartoon. The reaction of the brain to each cartoon was then measured using functional MRI (fMRI). The researchers soon found out that the funny cartoon activated a network of subcortial regions including the nucleus accumbens, the center of the pleasure-, reward-, and happiness center, and a key component of the mesolimbic dopaminergic reward system. Containing nerve cells that use the neurotransmitter dopamine for transducing chemical signals, this is where the feelings of happiness and euphoria are generated, which can be trigged by situations of success, a cartoon or joke, or drugs like cocaine.

The study then looked at the degree of the humor intensity, making use of the fact that most fMRI techniques are sensitive to susceptibility variations and rely on the change in blood oxygenation level in response to neuronal activation (BOLD effect). The findings confirmed that the degree of humor intensity was positively correlated with BOLD signal intensity in the subcortical regions.

This kind of study could help in shedding further light on the early stages of depression and its altering effect on humor appreciation. The effect of humor could also be compared with the effect of drug consumption because both trigger the release of dopamine and affect the same region of the brain, which could give clues about the origins of addiction.

• For more information about the study, see Neuron 40 (5): 1041-8, 2003.
  
  
• Find more detailed information in Color Atlas of Neuroscience
  and other Thieme neuroscience and neuroradiology titles.
  
  
• To share a laugh, please email us your funniest joke or cartoon. The best entry will be published on thieme.com!
  
  
• For a related article in German, please visit Via Medici.

Fibroadenomas are the most common positive findings during a female breast examination. Fibroadenomas can develop into breast cancer at a later stage, and as such, even benign tumors used to be surgically removed as a precaution.. Today, fibroadenomas are excised only when a certain amount of growth suggests a potential development into breast cancer.

A recently published study conducted at the University of British Columbia, Vancouver, Canada (Radiology 2003; 229: 233-238) monitored fibroadenomas that were not removed even after reaching a certain size, and allowed them to grow further. Instead, the breast lesions diagnosed as fibroadenomas of 1,070 patients were measured three times intitially and were then followed-up regularly by ultrasonographic exams. The change in dimensions was then monitored according to the patient's age and the amount of time the fibroadenoma took to grow.

The study concluded that it is safe to assume that a fibroadenoma will develop into breast cancer only when the tumor grows by more than 20 percent over a time period of six months. All excised masses with slower growth proved benign at histologic examination.

Prof. Ingrid Schreer from the mammography center at the University of Kiel, Germany commented on the study in the Thieme journal German Medicine Weekly (DMW 2004; 129 (5): 180) and cautions to employ this "wait-and-see attitude" only when dealing with smaller fibroadenomas (3 cm/1.2 inches or less). She also mentions that the doctor must have a good amount of experience, as well as access to high-end equipment, before being able to make the diagnosis.

• The Canadian fibroademona study
  
  
• Prof. Schreer's book, Diagnostic Breast Imaging
  
  
• DMW (German Medicine Weekly, in German)
  
  
• More Thieme breast imaging books

According to a recently published study by Finnish researchers at the Turku University Hospital in Turku, Finland, survival rates of women whose breast cancers are found by mammography are better than of those found by clinical examination.

The study evaluated data gathered from women who participated in the city's free mammography screening program, following a population of 36,000 women over the period of 11 years. Breast cancer kills approximately half a million women each year worldwide, and most physicians cannot stress the importance of early detection enough. Months can make a difference, and the earlier a diagnosis is made, the better are survival rates, treatment options, and surgical outcomes.

Thieme author and the world's leading mammographer Dr. Laszlo Tabar commented on the study, emphasizing the importance of training for radiologists, as well as their cooperation with breast surgeons, pathologists, and oncologists. In the third edition of Drs. Tabar's and Tot's Teaching Atlas of Mammography, the authors share their extensive data about women diagnosed with breast cancer compiled over the course of two decades. Such extensive follow-up is invaluable for understanding the variations in normal and pathological breast anatomy.

Having read more than one million mammographic screening evaluations himself, Dr. Tabar describes the interpretation of mammograms as a two-step process involving perception and analysis: "Since the greatest benefit of mammography lies in the detection of breast carcinoma in its earliest possible stages, every mammogram must be systematically surveyed for the subtle hints of malignancy" (from the Introduction).

More information:
Tabar/Tot, Teaching Atlas of Mammography

Dr. Tabar's evaluation of the Finnish study on BreastLink.org

More Thieme books on breast imaging and radiology

More Thieme mammography news

Complementary medical treatments such as acupuncture, homeopathy, and naturopathy, have become increasingly popular with the patients as well as traditional practitioners, especially over the last decade. Two recently published studies examine the effectiveness of acupuncture treatments.

One of them, conducted at the Charité University Hospital in Berlin, Germany came to the preliminary result that acupuncture can provide a lasting cure against a variety of ailments such as migraines, seasonal allergies, or back pain. The Institute of Social Medicine, Epidemiology, and Health Economics at the Charite Hospital has been looking at the effectiveness of methods used in Traditional Chinese Medicine (TCM) for three years.

The extensive study that thusfar involves 49,000 patients in approximately 6,800 primary care centers, collects data using patient questionnaires to be filled out at baseline, 3 months, and 6 months. Participating physicians then document each patient's case history, treatment and therapeutic success. The study's three primary goals are examining the effectiveness of acupuncture under everyday conditions, determining its cost-effectiveness including the costs of possible side effects, and measuring its safety.

The study documents that 70- 90% of the patients have noticed an improvement in their condition after being treated with acupuncture. This result is higher than those of traditional treatment methods. Nine out of ten people with seasonal allergies, and three out of four with head or neck pain noticed an improvement in their well being that even lasted up to six months after their treatment. To date, only 0.5% of patients experienced side-effects requiring some form of treatment. Expected to last until 2008, the study will further look into the psychological effects of acupuncture.

The second study, recently published in the journal Anesthesia & Analgesia (2004; 98: 141-147), measured the healing effects of acupuncture scientifically, responding to the common notion that the effect of acupuncture on pain perception is controversial. The study by the Friedrich-Schiller University in Jena, Germany documents the electrophysiological effects when reacting to pain. The participating physicians from the departments of Anesthesiology and Intensive Care and Biological and Clinical Psychology subjected their anesthetized volunteers to pain stimuli that were then treated with electric needles on traditional acupuncture points of the leg. By monitoring the reaction to the pain through recording the brain waves (somatosensory evoked potentials or SEPs), it was possible to measure the pain-reducing effect of acupuncture.

Measuring the brain activity revealed differences in the reaction of the human body to pain with and without acupuncture. Anesthesizing the volunteers guaranteed that their knowledge of being treated with acupuncture would not falsify the results or produce a placebo effect. Results showed that it was possible to lessen the pain when using acupuncture, but not to completely eliminate it. They also showed that the effectiveness of complementary medicine can be scientifically proven.

For more information about either study, visit the Charite website or Anesthesia & Analgesia.

To read a related article in German, please visit Via Medici.

For more information about acupuncture and treatment methods, consult Thieme's TCM and Acupuncture titles:

  

Hecker et al, Color Atlas of Acupuncture

  Rubach, Principles of Ear Acupuncture (Book+CD)

  

Strittmatter, Ear Acupuncture

   Strittmatter, Identifying and Treating Blockages to Healing

Click here to see a list of all our Complementary Medicine titles and sign up here for our CAM eNews.

A new high-end 1.5T MRI system developed by Siemens allows whole body functionality, for the first time in MR history. The procedure improves the quality of the image for more precise diagnosis, such as metastases evaluation.

It also makes the procedure easier for the patient because with this new system, most scans can easily be performed with the patient's head outside the bore. The worldwide first MR-System with TIM-technique (Total Imaging Matrix), called Magnetom Avanto, has been presented at the Radiological Society of North America (RSNA) meeting in 2003, as well as the Tübingen University Hospital in Germany at the end of November. Siemens has also developed an upgrade program which will make it possible to expand older Siemens MR-systems.

What it is?
"Total Imaging Matrix" means that 76 integrated matrix coil elements and signals can be received across 32 receiver channels, leading to four times sharper images, supporting a total field of view of up to 205 cm (6' 9''). Current systems can receive signals from up to eight channels at the same time and a total field of view of up to 105 cm (3' 5''). Before, whole body images had to be put together like a jigsaw puzzle, but this revolutionary system enables an efficient and complete evaluation.

What are the patient advantages?
With the new system, the patient can be examined seamlessly from head to toe without using different local coils or repositioning. It is now possible to scan the patient feet-first, leaving the head outside the bore, therefore avoiding uncomfortable feelings of claustrophobia. In addition, taking a whole body tomography now only takes 12 minutes, less than half the time of the currently fastest machines. Another advantage is that the coils, usually placed on the patient's chest and stomach, are lighter because of their open construction. The new Body-Matrix-Coil weighs only 950 grams-- only half of conventional ones. The creators of Magnetom Avanto have also considered making the whole process quieter: The AudioComfort function suppresses the acoustic noise that develops when the coils are changed in the bore, resulting in a reduction of acoustic noise of up to 30 dB(A).

The benefits of this new technique extend from more accurate diagnosis to improved patient comfort, and it is anticipated to thoroughly update MR imaging for a quicker and more efficient process.

Related Thieme titles

Read this article in German (Röfo, 12/2003).

HHS Secretary Tommy G. Thompson announced on December 30, 2003 that the Food and Drug Administration (FDA) has issued a consumer alert on the safety of dietary supplements containing ephedra. The FDA notified manufacturers of its intent to publish a final rule on dietary supplements containing ephedrine alkaloids, stating that "dietary supplements containing ephedrine alkaloids present an unreasonable risk of illness or injury".

Once in effect, (usually following 60 days of publication), the FDA rule would ban the sale of dietary supplements containing ephedra. This would not mean however, that all supplements containing ephedra would be off the market because interestingly, the rule excludes traditional Chinese herbal remedies. Other remedies like herbal teas would fall under conventional food regulations.

Related Thieme titles

More:
U.S. Department of Health & Human Services (HHS) press release

National Center for Complementary and Alternative Medicine (NCCAM) consumer advisory