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Thursday, March 30, 2023

Hello Health Rounds readers! Today we're highlighting an innovative new blood vessel re-engineering procedure that helps avoid amputation in patients on the verge of losing a foot. We also share a report on a breast-sparing option for women with newly discovered tumors in one breast, and welcome news for male cannabis users concerned about their fertility.

In breaking news, see these stories from our Reuters journalists: Texas judge blocks Obamacare coverage mandate for preventive care; ss weight-loss drugs hit the U.S. market, doctors debate how to use them; and UnitedHealth reduces prior authorization requirements for non-urgent procedures.

The psychoactive component of marijuana impairs men's fertility, but abstaining for a few months partially reverses those effects, researchers say. REUTERS/Eduardo Munoz.

Surgeons have figured out how to turn a vein into an artery in order to avoid amputation in people with severely blocked blood flow to the feet, according to a report published on Wednesday in The New England Journal of Medicine.

The study involved 105 patients whose calf arteries were clogged so severely they developed non-healing wounds and gangrene due to a lack of oxygen-carrying blood able to reach the tissues. All had exhausted other treatment options and were facing amputation.

Veins normally carry blood to the heart, not to the tissues. Using customized equipment manufactured by study sponsor Limflow Inc, surgeons connected a vein to a clogged artery at a site ahead of the blockage and redirected the arterial blood into the vein. Next, they deactivated the valves in the vein that usually direct blood to the heart, allowing it to flow toward the oxygen-starved tissues.

Six months later, two-thirds of the patients were still amputation-free, although some had required additional interventions to optimize blood flow, according to study leader Dr. Mehdi Shishehbor of University Hospitals Harrington Heart and Vascular Institute in Cleveland and colleagues.

A quarter of wounds had completely healed, and another 51% were in the process of healing, researchers reported.

In an accompanying editorial, Dr. Douglas Drachman of Massachusetts General Hospital in Boston called the new procedure "a novel – if not audacious – approach."

Still unclear, is whether the repurposed blood vessels will themselves eventually become clogged. And are all patients with such limb-threatening blockages likely to benefit, or are some – such as those with kidney failure – likely to have poorer outcomes?, he asked.

Despite those uncertainties, this novel option "offers potential promise for patients who would otherwise often be relegated to amputation," Drachman wrote.

Abstaining from marijuana for several months can partially reverse its adverse effects on male fertility, according to a study in monkeys.

The findings would likely be similar in humans, researchers said in their report published on Sunday in Fertility and Sterility.

The researchers administered THC, the major psychoactive component of cannabis, to adult male monkeys every day for seven months. They found that THC negatively affected the quality and quantity of sperm, size of the testes, and male reproductive hormone levels.

When the researchers withheld the THC for 20 weeks, the animals' testes returned to 73% of their original size, and hormone levels and sperm quality also increased, they reported.

"Given the biological similarities between humans and nonhuman primates, specifically with the production and development of sperm and endocrine signaling (how hormones like testosterone tell other cells in the body what to do), we believe similar results to our study will be observed in men using cannabis," said study leader Dr. Jamie Lo of the Oregon Health and Science University in Portland.

As legalization of cannabis becomes more widespread, research into the impact of THC on reproductive health becomes increasingly important, Lo said, adding that the data can help inform healthcare professionals and those wanting to conceive.

A mastectomy may not automatically be required for women with multiple tumors in the same breast, new research shows.

Historically, women with multiple tumors in one breast have been advised to have the breast removed. Now they can be offered a less invasive option with faster recovery, Dr. Judy Boughey of the Mayo Clinic in Rochester, Minnesota, who led the research, said in a statement.

Her team studied 204 women over age 40 with two or three early-stage cancers in a single breast who were interested in avoiding mastectomy. The women had lumpectomies to remove the tumors, followed by whole-breast radiation plus extra radiation targeted to each lumpectomy site.

Over the next five years, 3% of the women had local recurrences, a rate similar to patients with a single tumor in a breast who have breast-conserving therapy, the researchers reported on Tuesday in the Journal of Clinical Oncology.

Most of the patients were postmenopausal, with estrogen receptor (ER)–positive/human epidermal growth factor receptor 2 (HER2)–negative breast cancer and with two sites of disease. None of those characteristics was predictive of recurrence, researchers said.

There was, however, a significantly higher recurrence rate in the 15 women who had not had an MRI exam before surgery. In this group, the five-year local recurrence rate was 22.6%, compared with 1.7% in the larger group of women who did have preoperative MRIs to confirm the extent of their cancer.

An MRI before surgery should be considered to ensure there is not more extensive disease, Dr. Boughey said.

"Some patients may still prefer or require a mastectomy, and that is a perfectly fine approach," she added. "But being able to provide more patients diagnosed with breast cancer with a choice is a great step forward."

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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