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San Francisco Medicine, March/ April 2006. Hands and High Technology: Minimally Invasive Procedures.

Transcript of March/ April 2006

  • www.sfms.org mArCH/APrIL 2006San FranciSco MedicineSan FranciSco MedicinemArCH/APrIL 2006 www.sfms.org

  • San FranciSco MedicinemArCH/APrIL 2006 www.sfms.orgSan FranciSco MedicinemArCH/APrIL 2006 www.sfms.org

  • San FranciSco MedicinemArCH/APrIL 2006 www.sfms.org www.sfms.org mArCH/APrIL 2006San FranciSco MedicineSan FranciSco MedicinemArCH/APrIL 2006 www.sfms.org

    conTenTS

    San FranciSco Medicine March/april 006 Vol. 79, #

    Hands and High Technology: Minimally invasive Surgery

    FEATURE ARTICLES

    Is Coronary Bypass Surgery Obsolete in the Era of Drug-Eluting Stents? PeterHui,MD,FACC,FSCAI

    6 Interventional Neuroradiology: Less Invasive Approaches For The Treatment Of Complex Cerebrovascular Diseases & Stroke RandallT.Higashida,MD

    9 Non-Surgical Techniques and Modalities for Skin Rejuvenation GaetanoZanelli,MD

    Screening for Abdominal Aortic Aneurism with Ultrasound can Save Lives GretchenAWGooding,MD

    Phoenix Rising: And the Big Bird is Looking Through a Laparoscope LeonardShlain,MD

    5 The Past, Present, and Future of Laparoscopic Colectomy 2006 LaurenceF.Yee,MDandMichaelE.Abel,MD

    MEMBER SERVICES

    4 On Your Behalf

    Report from the San Francisco Department of Public Health: A Successful Community Hepatitis B Screening and Vaccination Program JanetZola,MPH,EricSue,BA

    MONTHLY COLUMNS

    7 Executive Memo MaryLouLicwinko,JDMHSA

    9 Presidents Message GordonFung,MD

    Editorial MikeDenney,MD,PhD

    8 Hospital News

    OF INTEREST

    6 Letter to the Editor: DavidSmith,MD

    8The San Francisco Earthquake 1906: Quick Action Saved Countless Lives NancyThompson,MD

    0Surgeons Volunteer Locally through Operation Access: HaileDebas,MDand PaulB.Hofmann,Dr.PH

    Removing Bad Money from Good Medicine: Time for Some Bitter Pills: GeorgeSusens,MDand SteveHeilig,MPH

    4SFMS Annual Dinner Report

    7Report Links Environmental and Occupational Exposures to Cancers: RichardClapp,DSc,MPH,and MollyJacobs,MPH

    Editorial and Advertising Offices

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  • 4San FranciSco MedicinemArCH/APrIL 2006 www.sfms.org4San FranciSco MedicinemArCH/APrIL 2006 www.sfms.org

    on YoUr BeHaLF

    ediToriaLSan Francisco Medicine continues to Publish:TheEditorialBoardofSanFrancisco

    Magazinehasbeenworkingdiligently tomaintaincontinuityofourpublicationaftertheabrupt lossofourpreviousManagingEditor.Becauseof the timedelayscausedbymovingintothenewSFMSoffices,thevacancywhilesearchingforanewManag-ingEditor,andtheresultantdisruptionofthenecessaryflowof thepublishingpro-cess,wehavefounditchallengingtokeepthepressesrolling.Wehavethusfounditnecessary-temporarily-tocombineafewissuesthisSpringratherthanhavingoneeachmonth.

    Asaresultofthededicatedeffortsofmembers likeGretchenGooding,NancyThomson, SteveWalsh,Gordon Fung,EricaGoode,andmanyothers,andwithSteveHeiliggracefullyandskillfullystep-ping into thebreach,youare receivingaMarch/April issue aboutnewminimallyinvasiveprocedureswhichwe thinkyouwillfindhighlyinterestingandinformative.WewillthenhaveaMay/Juneissuewithathemeofdiversityandmedicine.

    Ourhighly competentnewManag-ingEditor,AmandaDenz, starts thefirstofApril.So,wehavetakenadeepbreath,hunkereddowntowork,andexpecttore-turntonormalschedulesoon.Ourwebsite,www.sfms.org,isalsostillaworkinprogress.ThoseseekingtoaccessthearchivesofthisjournalbuthaveproblemsdoingsoshouldcontactSFMSheadquartersforassistance,asthecontentsdatingto1996remainonthesite.Ourthanksgoouttoallmembersforyourpatienceandsupport.

    The SFMS Board of directors invites all members to:The SFMS Open HouseCome see ournewheadquarters in thePresidioFriday,April283-6PMHorsdouvresandrefreshments1003AOReillyAvenueBetweenGorgasandTorneyAvenuesinthePresidio,SanFrancisco

    A sampling of activities and actions of interest to SFMS members.

    RSVPtoCarolNolanat561-0850,ext.0orcnolan@sfms.org

    Medicine and Patients ScoreMajor Victory at Supreme court

    InJanuarytheUnitedStatesSupremeCourtruledinfavorofpatientsandphysi-cians in the longstandingcaseGonzales(originallyAshcroft) vs.Oregon.TheUnitedStatesAttorneyGeneral(s)hadsought tooverturnOregons legalizationofassistedsuicidebyradicallychangingthe regulationand scrutinyofprescribedmedications.While theSFMSdoesnottakeaformalpositionontheassisteddyingissue(duetotheverydividedopinionsofourmemberson the topic),wedidagreewithexpertswho felt that theAshcroft/Gonzalesproposalwouldlikelyaddtothelongstandingconcernsofphysiciansaboutoveruseofpainmedicationsinparticular.TheSFMStookanopposingpositiontotheproposal,convincedtheCMAtodolike-wise,andjoinedinaFriendoftheCourtbrief alongwithmanynationally-knownpain specialistsandhealthpolicyfigures.Thecasetookyearstowinditswaytofinalresolution,butoneattorney in the caseremarked that the supportofmainstreammedical organizations such as ourswasinvaluableintheoutcome.

    cMa coalition Stops 5 Percent Medi-cal rate cut

    ThegovernorsignedaCMA-sponsoredbill(SB912)thateliminatesthe5percentMedi-CalratecutthattookeffectJanuary1.

    Thecuttheresultofalawsignedin2003byGovernorDaviswasscheduledtostartJanuary1,2004,andsunsetJanuary1,2007.In2003theCMAwonafederalcourtinjunctionblockingthecut,butthatinjunc-tionwasoverturnedinAugust2005.

    CMAandabroadcoalitionofpatientandprovider organizations immediatelysoughtemergencylegislationtostopthecutandprotectaccesstocareforthe3millionpoor,children,elderly,anddisabledwhorelyonMedi-Calfortheirhealthcare.Thebill

    MarcH/aPriL 006Volume 79, number

    Editor Mike Denney, MD, PhDManaging Editor Amanda DenzCover Artist Alex Rothwell

    Editorial BoardChairman Mike DenneyObituarist Nancy ThomsonStephen Askin Wade Aubry Toni Brayer Corey Maas Jaqueline Dolev Jerome Fishgold Alan Greenwald Erica Goode Gretchen Gooding Samuel Kao Thomas Lee Arthur Lyons Rita Melkonian Kenneth MayburyJudith Mates Ricki Pollycove Jordan Shlain Leonard Shlain David Smith Kathleen Unger Leo van der Reis Stephen Walsh Shieva Khayam-Bashi

    SFMS oFFicErSPresident Gordon L. FungPresident-Elect Stephen E. FollansbeeSecretary Charles J. WibbelsmanTreasurer Stephen H. FugaroEditor Mike DenneyImmediate Past President Alan G. Greenwald

    SFMS Executive StaffExecutive Director Mary Lou Licwinko, JD, MHSADirector of Public Health & Education Steve L. Heilig, MPHDirector of Administration Posi LyonDirector of Membership Therese Porter

    Board of directorsTerm: Jan 2006-Dec 2008Mei-Ling E. Fong, MDThomas H. Lee, MDCarolyn D. Mar, MDRodman S. Rogers, MDJohn B. Sikorski, MDPeter W. Sullivan, MDJohn I. Umekubo, MD

    Term: Jan 2005-Dec 2007Gary L. Chan, MDGeorge A. Fouras, MDJeffrey Newman, MDThomas J. Peitz, MDJohn W. Pierce, MDDaniel M. Raybin, MDMichael H. Siu, MD

    Term: Jan 2004-Dec 2006Richard L. Caplin, MDLucy S. Crain, MDJane M. Hightower, MDBrian J. Lewis, MDMichael Rokeach, MDJordan Shlain, MDAlan M. Teitelbaum, MD

    CMA Trustee Robert J. MargolinAMA RepresentativesH. Hugh Vincent, DelegateJudith L. Mates, Alternate DelegateJudith L. Mates, AMAs Women Physicians Congress Governing Committee

  • 4San FranciSco MedicinemArCH/APrIL 2006 www.sfms.org www.sfms.org mArCH/APrIL 2006San FranciSco Medicine54San FranciSco MedicinemArCH/APrIL 2006 www.sfms.org

    passedunanimously inbothhousesof thelegislature,andwassignedbythegovernorwithin24hours.

    Evenwithoutthecut,Medi-Calrateshavenotkeptpacewithinflation,andper-patientMedicaidspendingbyCaliforniarankslastamongthe50states.CMAiscommittedtoworkingwiththegovernor,thelegislature,andotheradvocacygroupsonMedi-Calre-formsthatwillimproveprogramefficienciesandcontrolcosts,whilemaintainingaccess,continuity,andqualityofcareforMedi-Calpatients.

    Contact:LisaFolberg,916/444-5532orlfolberg@cmanet.org.

    cdc advisory Panel recommends Flu Shots for children Under 5

    TheCenters forDiseaseControl&Preventions immunizationadvisorycom-mitteerecommendedthatallchildrenunder5andover6monthsbevaccinatedagainstinfluenza,currentguidelinescallforchildren6to24monthsoldbevaccinated.

    Physicians shouldalsobeaware thateffectiveJuly1, itwillbeagainstCalifor-nialawtoadministermercury-containingvaccinesincludinginactivatedinfluenzavaccinefrommultidosevialstopregnantwomenandchildrenyoungerthan3yearsold.Nextfluseason,onlydosesofinfluenzavaccine fromsingle-dose syringesorvialswithtracelevelsornomercurymaybegiventothesegroups.

    Contact:RobinFlagg,415/882-5110orrflagg@cmanet.org.

    Physicians, Beware of Mislead-ing Medem invoices

    AnumberofphysicianshavereportedtoCMAthattheyhavereceivedunsolic-itedinvoicesfromMedem,chargingthem$195 for PracticeWebSiteand iHealthServices.Physiciansshouldbeawarethattheseinvoicesareoffersofservice,notac-tualbills.Whiletheservicesbeingofferedarelegitimate,youdonotneedtopaytheinvoiceunlessyouactuallywanttosignupforMedemsservices.

    CMAhas expressed its concern toAMA,apartownerofMedem,aboutthese

    misleadingsolicitations.AMAhasassuredCMAthatitisworkingwithMedemtostopthisuntowardmarketingpractice. In themeantime,physiciansshouldinformtheirofficestaffofthisissue.

    Contact:CMAslegalinformationline,415/882-5144orlegalinfo@cmanet.org.

    cMa Sponsors Bill to eliminate Physician Participation in execu-tions

    Reacting toanattemptby stateof-ficialstohavephysicianstakeanactiveroleinexecutingMichaelMorales,aprisoneratSanQuentinStatePrison,CMAannouncedthisweek that it is sponsoringabill thatwouldeliminatephysicianinvolvementinallfutureexecutions.

    Physicianssho