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Wednesday, November 2, 2011

Gastric balloon plan for children

 Overweight teenagers in South Yorkshire could be fitted with gastric balloons, if a trial is approved.

Sheffield Children's Hospital said it wanted to use the balloons to help 10 morbidly obese 13 to 18-year-olds lose weight.

Those weighing between 14 and 20 stone (89kg-127kg) will be considered.

Dr Neil Wright from the hospital said the procedure was "intended as an option for young people where other treatments have not been successful".

The hospital said the procedure had been found to be effective for adults but very few studies had been carried out on young people.

The gastric balloon discourages overeating by inflating in the stomach to give the feeling of being full.

Dr Wright, a consultant paediatrician and obesity specialist, said: "The gastric balloon is a treatment normally for adults and which, as far as we know, has never been trialled with teenagers in the UK.

"We see it as a possible alternative to gastric surgery for young people with severe weight problems.

"If the trial is approved the team will be working with youngsters over a two-year period to see if the balloons will kick-start weight loss and, with the help of the behavioural support programme, keep the weight off in the long term.

"This is not a quick fix as the lifestyle advice and support is very important in helping young people to lose weight and giving them the information they need in the future to manage a healthy lifestyle."

Lisa Beardsmore, from Rotherham, whose son is overweight said: "I don't think surgeons should be offering children at this age such drastic measures. Who is to say that your child won't change themselves?

"The correct way is for children to eat three balanced meals a day."

If the proposal is given the go-ahead by the hospital's ethics committee, the trial would last for two years.

Patients would be recruited through hospital consultants, GPs and patients requesting referrals.

Gene therapy 'to protect sight'

  By Pallab Ghosh Science correspondent, BBC News  Jonathan Wyatt: Hoping doctors can save his sight so he can continue to work as a lawyer Researchers in Oxford have treated a man with an advanced gene therapy technique to prevent him from losing his sight.

It is the first time that anyone has tried to correct a genetic defect in the light-sensing cells that line the back of the eye.

The president of the Academy of Medical Sciences said the widespread use of gene therapy of this treatment will be soon be possible.

The operation was carried out on 63-year-old Jonathan Wyatt, an arbitration lawyer based in Bristol.

Mr Wyatt was able to see normally until about the age of 19 when he began having problems seeing in the dark.

He was told by doctors that his vision would get progressively worse and he would eventually go blind.

The gradual deterioration in his vision didn't stop Mr Wyatt from qualifying as a barrister. But 10 years ago he found he was having difficulty reading statements in dimly-lit courts.

"The worst occasion was when I was reading out a statement to the court and I made a mistake. The judge turned to me and snapped 'Can't you read Mr Wyatt?!' I then decided it was time to put my wig down and leave advocacy."

Geneticist Dan Lipinski, from the University of Oxford, explains the gene therapy process

Mr Wyatt is able to see well enough to work from home and hopes that the operation will enable him to continue his profession.

Without treatment he would be blind within a few years and would be unable to work in the way that he is doing so now.

"I'd like things to get a little better," he says.

Devastating diagnosis

Mr Wyatt suffers from a rare genetic disorder known as Choroideraemia.

These patients start off life with normal vision and its not until their late childhood that they notice that they cannot see anything at night and usually the diagnosis is made during middle to late childhood.

From then it is a devastating diagnosis because these young people are told that they are gradually going to lose their sight completely, usually by the time they are in their 40s. There is no treatment for this condition.

The disease is caused by an inherited faulty gene, called REP1. Without a functioning copy of the gene, the light detecting cells in the eye die.

The idea behind the gene therapy is simple: stop the cells from dying by injecting working copies of the gene into them.

It is the first time that anyone has attempted to correct a gene defect in the light-sensing cells that line the back of the eye.

Mr Wyatt is the first of 12 patients undergoing this experimental technique over the next two years at the John Radcliffe Hospital in Oxford.

His doctor, Prof Robert MacLaren, believes that he'll know for sure whether the degeneration in Mr Wyatt's eye has stopped within two years. If that's the case his vision will be saved indefinitely.

"If this works with then we would want to go in and treat patients at a much earlier stage in childhood, effectively where they still have normal vision and can do normal things to prevent them from losing sight.

Prof MacLaren believes that if this gene therapy works it could be used to treat a wide variety of eye disorders, including the most common form of blindness in the elderly, macular degeneration.

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I have no personal doubt in future that there will be a genetic treatment for macular degeneration”

End Quote Prof Robert Maclaren John Radcliffe Hospital, Oxford "That is a genetic disease and I have no personal doubt in future that there will be a genetic treatment for it," he says.

The Oxford research follows on from a gene therapy trial which began four years ago at Moorfields Hospital in London. The principle aim of these trials was to demonstrate that the technique was safe.

The treatment, which adopted a slightly different approach, was tested first in adult patients whose sight was almost gone, and then in children.

According to Prof Robin Ali, who led that research, the trials have shown not only that gene therapy is safe - but that there has been significant improvement in some patients.

"It is very exciting to see the start of another ocular gene therapy trial and the field moving so rapidly in recent years," he said.

"In the last 12 months, several new gene therapy trials for the treatment of various retinal disorders have been initiated and further trials are likely to start very soon. We are all looking forward to seeing the results."


The concept of using gene therapy for treating a whole host of conditions has been around for more than 20 years. But with, some notable exceptions, it's an idea that's failed to live up to its hype.

Now, however, it seems that the technique is beginning to deliver, at least in treating sight disorders.

According to Prof Sir John Bell, president of the Academy of Medical Sciences, these very early trails in Oxford, London and in the US suggest that a whole host of sight disorders could, be treatable "within the next 10 years".

"Of all the things that are available for this particular set of diseases this is by far the most exciting," he said.

"This is a set of diseases where molecular medicine has reached a point where we can now intervene in a very precise way to correct the defect that caused the blindness in the first place. There is the possibility that you could actually correct the gene defect."

The trial, led by Oxford University, has been jointly funded by the Wellcome Trust and Department of Health. It is an example of a new approach to medical research which brings together scientists and clinicians to translate basic science into effective treatments more quickly

"This is exactly where the NHS ought to be putting its effort and it's a perfect example of the benefits that might from using the NHS for this kind of research activity," said Prof Bell.

Glowing brain tumour trial begins

 By James Gallagher Health reporter, BBC News  The tumour glows under UV light The idea of making brain cancers glow to help surgeons operate is being tested in the UK.

Patients will be given a drug, 5-amino-levulinic acid (5-ALA), which causes a build-up of fluorescent chemicals in the tumour.

The theory is that the pink glow will clearly mark the edges of the tumour, making it easier to ensure all of it is removed.

More than 60 patients with glioblastoma will take part in the trial.

They have cancerous glial cells, which normally hold the brain's nerves cells in place. On average patients survive 15 months after being diagnosed.

No room for error

In some cancers, such as those of the colon, some of the surrounding tissue can be removed as well as the tumour. Removing a brain tumour needs to be more precise.

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Treating brain tumours is a real challenge facing clinicians and we urgently need new treatments”

End Quote Kate Law Cancer Research UK Dr Colin Watts, who is leading the trial at the University of Cambridge, told the BBC that surgeons "don't want to take too much functional tissue away".

The trial will then test whether applying drugs directly to the tumour improves survival rates.

After the tumour has been removed under UV light, a thin drug-soaked wafer will be placed in the space left behind. This should slowly release chemotherapy drugs over four to six weeks to kill any remaining cancerous cells.

This could overcome one of the challenges with chemotherapy for brain tumours.

Dr Watts said: "One of the problems with chemotherapy is we don't actually know the extent a drug penetrates a tumour because of the blood brain barrier."

By applying the drug directly to the tumour it should be at a higher dose.

Charles Meacock, 56, from Norfolk, who has already taken part in the trial, said: "Hopefully it will benefit me, but will also help people in my situation in the future.

"It's four weeks since my surgery and my recovery seems to be going as it should. I just have to wait and see now."

The study has been funded by the Samantha Dickson Brain Tumour Trust and Cancer Research UK.

The founder of the Samantha Dickson Brain Tumour Trust, Neil Dickson, said he was proud to be funding the trial.

"Brain tumour research receives a fraction of the funding of that of higher profile cancers and it is our priority to redress the balance," he added.

Kate Law, Cancer Research UK's director of clinical research, said: "Treating brain tumours is a real challenge facing clinicians and we urgently need new treatments to help more people diagnosed with the disease."

Trials involving more patients will take place if this one is successful.

Hospital patients 'still at risk'

 Patients at Romford's Queen's Hospital "remain at risk"

Patients are still at risk at an east London hospital, according to a health watchdog report after the deaths of two pregnant women.

The Care Quality Commission (CQC) review began in June after the deaths of Tebussum Ali and Violet Stephens at Queen's Hospital in Romford.

Mrs Stephens died in April and Ms Ali and her baby died in January.

The Barking, Havering and Redbridge University Hospitals NHS Trust said it would improve.

The CQC report identified "serious problems" and placed requirements on the trust to deliver "fundamental and wide-ranging improvements".

Midwives suspended

The report said: "Despite some signs of improvement in recent months, patients remain at risk of poor care in this trust.

"While the most immediate concerns were around maternity services, failings were also identified in emergency care and in radiology.

Continue reading the main story Verbally abusive and unprofessional behaviour by some staff to patientsLack of leadership from senior managementVacancies repeatedly filled by agency staff, reducing quality of care"Widespread improvement is needed in patient flows, the management of complaints, staff recruitment and governance in order to improve patient experience."

An independent report found in the case of Mrs Stephens, who was admitted with potentially life-threatening pre-eclampsia, there was a failure to give a blood transfusion and a delay in making the decision to deliver her baby.

In the case of Ms Ali, who was also known as Sareena, the report found staff had failed to spot signs of her ruptured womb and tried to resuscitate her with a disconnected oxygen mask.

Tebussum Ali and her baby died in January

Health Secretary Andrew Lansley said the standard of care provided by the trust must improve substantially.

"We should be prepared to shine a spotlight on problems where they exist, because poor performance is not just a statistic or a line on a graph.

"It means patients being let down, or hurt, or worse."

The CQC inquiry found the most significant problems were at Queen's Hospital, although elements of poor care were present across both of the trust's main sites.

However the CQC said leadership of the trust was improving due to the efforts of a new chief executive and medical director.

Speaking after the publication of the report, the trust's chief executive Averil Dongworth said: "We are taking the findings of this report extremely seriously and have already started work to implement its recommendations.

"We recognise that there have been failures in the past, but we are determined to continue to improve until we are among the best trusts in the country."

She said seven members of staff had already or were in the process of being disciplined and there were more to follow.

The trust also said it had recruited an extra 72 midwives this year and had improved staff support and training.

Lawyer Sarah Harman, who is taking legal proceedings on behalf of 20 maternity patients of Queen's Hospital, said: "For patients to receive a reasonable standard of care there needs to be a significant change in the staff culture.

"Patients' concerns should be listened to and their complaints acted on.

"Had this happened in the past, the tragedies in the maternity unit this year would have been avoided."

Director of nursing Deborah Wheeler said the trust was unable to comment on the legal action.

The government has said plans to move maternity and emergency services to Queen's Hospital from King George Hospital in Ilford can go ahead, as long as ministers are satisfied that services are safe.

Hospital tributes for Sir Jimmy

 Sir Jimmy Savile opening the new National Spinal Injuries Centre for which he raised millions Staff and patients at Stoke Mandeville Hospital have paid tribute to Sir Jimmy Savile following his death, aged 84.

The television and radio presenter raised millions to build the National Spinal Injuries Centre (NSIC) at the Aylesbury hospital.

Sir Jimmy began fundraising for the unit in 1972 after joining as a volunteer porter in 1969.

General Manager David Griffiths said: "We understand he effectively raised well in excess of £40m [for the unit]".

The NSIC was founded in 1944 by neurologist Professor Sir Ludwig Guttmann to treat servicemen who had sustained spinal cord injuries in World War II.

'Inspiring and uplifting'

"By 1979 the buildings were getting dilapidated and the ceilings were starting to cave in," explained Mr Griffiths.

"What Jimmy did was take up the cudgel and started raising money for us to reopen."

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If we, as patients of the hospital, felt that something needed to be done we could always go to him and he would use his influence”

End Quote Paul Smith Former patient Sir Jimmy's campaign raised £10m within three years and led to the creation of a purpose-built spinal cord injuries centre.

The new facilities opened in 1983, Sir Jimmy became its patron and continued to take an active interest.

"We were always delighted when he turned up," said Mr Griffiths.

"Every time he talked to a patient or a member of staff you could see them smile and light up. He had a canny knack of inspiring and uplifting everybody so he was a very, very valuable patron for us."

Paul Smith from Hertfordshire was a former patient and is now Executive Director at the Spinal Injuries Association.

"A great many spinal injury people really do owe him a debt because we don't know what the centre would have been like without all the input that he had," he said.

"He did have a lot of sway. If we, as patients of the hospital, felt that something needed to be done we could always go to him and he would use his influence."

'Slightly surreal'

Mr Smith first met Sir Jimmy when he was in the unit following a motorbike accident 36 years ago.

"I was head to toe in plaster and it was slightly surreal [coming round and] looking down to the end of your bed and seeing Jimmy Savile standing there," he said.

"As a volunteer he was always around and about, it was great to see him there and to realise that life could be a bit of fun."

Mr Smith saw Sir Jimmy again at an outpatients appointment and it was this encounter which led to an appearance on his BBC TV show Jim'll Fix It.

"I was thinking about going back to work and he suggested I became a DJ as I was a bit of a mouthy individual," explained Mr Smith.

Sir Jimmy suggested he do hospital radio and write to Jim'll Fix It asking to host it.

"He gave me about three quarters of the show to host which stood me in good stead and I got all sorts of contracts and work out of that."

The hospital was still planning to hold a celebration on 31 October on what would have been Sir Jimmy's 85th birthday.

"A book has been put together from all the staff and patients for him as a birthday card," explained Mr Griffiths.

"Very sadly he is never going to see it but we're going to keep hold of it for anybody who wants to see it because I think it reflects what staff and patients actually thought of Sir Jimmy, he was very, very well-loved."

IVF linked to ovarian tumours

 BBC News website  Fertility drugs are used to force the ovaries to produce eggs IVF has been linked to an increased risk of ovarian tumours in later life, according to a preliminary study.

Women given fertility drugs to produce eggs had more than triple the risk of an ovarian tumour that may turn cancerous, say Dutch researchers.

But the absolute risks are very low, they add.

A cancer charity said numbers involved in the study, published in the journal Human Reproduction, were too small to draw firm conclusions.

The study tracked more than 25,000 women attending IVF clinics in The Netherlands in the 80s and 90s.

Follow-up investigations revealed more cases than expected of ovarian tumours in women who had gone through IVF, which involves stimulating the ovaries to make eggs.

The biggest increase was in a type of growth, known as a borderline ovarian tumour, which can sometimes turn into cancer. It is less aggressive than other types of ovarian tumour, but requires surgery.

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Women should be informed about this but the risk should not be overstated”

End Quote Prof Flora van Leeuwen Netherlands Cancer Institute, Amsterdam It normally affects around one in 1,000 women in the general population, but was found in about 3.5 in 1,000 women who had gone through IVF, say the researchers.

A smaller increase in other types of ovarian tumour was also found. Overall, ovarian cancer rates were twice as high among women who had gone through fertility treatment, the experts said.

Prof Flora van Leeuwen, a co-author of the study, told the BBC: "The absolute risk of these tumours is very low. But there is an increased risk of a borderline malignant tumour that needs surgery.

"Women should be informed about this but the risk should not be overstated."

Another co-author, Prof Curt Burger added: "The main message is that women who have had IVF shouldn't be alarmed. The incidence of ovarian cancer was extremely low."


Further research is planned to confirm the finding in a larger number of patients, and to look at whether some women are more at risk.

At present, the numbers involved are small. There were 61 women with ovarian tumours in the IVF treatment group; 31 had borderline ovarian tumours and 30 had ovarian cancer.

Continue reading the main story Ovarian cancer is the 5th most common cancer in women in the UKMost cases are in women who are past the menopauseRisk factors include a family history of cancer, being infertile or having fertility treatment, and smokingThe symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages.Early symptoms can include pain in the lower abdomen or side, and/or a bloated, full feeling in the abdomenSource: Cancer Research UKCommenting on the study, Prof Hani Gabra, of the Ovarian Cancer Action Research Centre at Imperial College London, said:

"Reassuringly, and in keeping with lots of previous research in this area, this study shows that the risks of invasive ovarian cancer are small in populations of patients receiving ovarian stimulation for IVF.

"Although this study shows that ovarian stimulation may increase the risk of much less aggressive borderline ovarian tumours, it underlines the fact that ovarian stimulation for IVF is not a major risk factor for invasive ovarian cancer."

Dr Claire Knight, senior health information officer at Cancer Research UK, said: "This interesting study suggests a possible link between ovarian stimulation for IVF and borderline ovarian tumours, but it certainly doesn't show that IVF causes invasive ovarian cancer.

"There were only a relatively small number of cases in this study, and the researchers didn't find that risk increased with the number of cycles a woman had, making conclusions hard to reach.

"Women can reduce their risk of ovarian cancer by being a non-smoker and keeping a healthy weight, and women who have taken the Pill or been pregnant are also at lower risk."

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