Costlier robotic surgery soars for hysterectomies

CHICAGO (AP) — Robotic surgery is increasingly being used for women's hysterectomies, adding at least $2,000 to the cost without offering much benefit over less high-tech methods, a study found.

The technique was used in just 0.5 percent of operations studied in 2007, but that soared to almost 10 percent by early 2010. Columbia University researchers analyzed data on more than 260,000 women who had their wombs removed at 441 U.S. hospitals for reasons other than cancer. The database covered surgeries performed through the first few months of 2010.

Women who had the robotic operations were slightly less likely to spend more than two days in the hospital, but hospital stays were shorter than that for most women. Also, complications were equally rare among robotic surgery patients and those who had more conventional surgeries. Average costs for robotic hysterectomies totaled nearly $9,000, versus about $3,000 for the least expensive method, a different type of minimally invasive technique using more conventional surgery methods.

Traditionally hysterectomies were done by removing the womb through a large abdominal incision. Newer methods include removing the uterus through the vagina and minimally invasive "keyhole" abdominal operations using more conventional surgery methods, or surgeon-controlled robotic devices.

Robotic operations involve computer-controlled long, thin robot-like "arms" equipped with tiny surgery instruments. Surgeons operate the computer and can see inside the body on the computer screen, through a tiny camera attached to the robotic arms. The initial idea was for surgeons to do these operations miles away from the operating room, but robotic operations now are mostly done with the surgeon in the same room as the patient.

Theoretically, robotic surgeries make it easier to maneuver inside the patient, and are increasingly used for many types of operations, not just hysterectomies.

The main explanation for the big increase "is that robotic surgery has been marketed extensively to not only hospitals and physicians, but also directly to patients. There is minimal data in gynecology that it is advantageous," said Dr. Jason Wright, an assistant professor of women's health and the study's lead author.

The study was published Tuesday in the Journal of the American Medical Association.

"Our findings highlight the importance of developing rational strategies to implement new surgical technologies," the researchers wrote.

They note that 1 in 9 U.S. women will undergo a hysterectomy, usually after the age of 40. Reasons include fibroids and other non-cancerous growths, abnormal bleeding, and cancer.

Traditional abdominal operations remain common and more than 40 percent of women studied had them, costing on average about $6,600.

A JAMA editorial says the study doesn't answer whether the robotic method might be better for certain women, and says more research comparing methods is needed. Still, it says doctors and hospitals have a duty to inform patients about costs of different surgery options.

Dr. Myriam Curet of manufacturer Intuitive Surgical of Sunnyvale, Calif., said surgical robots can help surgeons overcome the limitations of other minimally invasive methods for very overweight patients, those with scarring from other surgeries and other complexities.

___

JAMA: http://www.jama.ama-assn.org

Robotic surgery: http://tinyurl.com/byuljds

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Read More..

Rapes may be tied to Christian dating website, officials say

Police in the San Diego suburb of La Mesa are investigating whether a 37-year-old man charged with raping a woman he met on the ChristianMingle website may have victimized other women he met on the dating website.

Sean Banks of Del Mar is charged with rape, burglary and penetration by force involving a woman in La Mesa, according to court records. He was arrested Feb. 11 and has pleaded not guilty.

Banks, a computer technician, worked in various locations across the United States. Police said they are investigating whether he may have lured other victims through ChristianMingle and other websites, possibly using pseudonyms, including Rylan Butterwood and Rylan Harbough.

In the La Mesa case, he used the name Rarity, police said. The alleged attack occurred in the woman's home the first time the two met in person after carrying on conversations over the Internet, police said.

Beverly Hills-based ChristianMingle is cooperating with the investigation, police said.

Anyone with information about Banks or other possible victims should call the La Mesa Police Department at (619) 667-7538.

ALSO:

Dorner stalked LAPD officials before killings, Chief Beck says

O.C. shootings: Ladera Ranch neighbor heard a 'bunch of ruckus'

Suspect in O.C. killings shot at drivers on 55 Freeway, police say

-- Tony Perry in San Diego

Photo: Sean Banks. Credit: La Mesa Police Department

Read More..

As Assad Holds Firm, Obama Could Revisit Arms Policy

WASHINGTON — When President Obama rebuffed four of his top national security officials who wanted to arm the rebels in Syria last fall, it put an end to a months-long debate over how aggressively Washington should respond to the strife there that has now left nearly 70,000 dead.

Reuters

A Free Syrian Army member smokes a cigarette inside a factory producing improvised mortar shells.

But the decision also left the White House with no clear strategy to resolve a crisis that has bedeviled it since a popular uprising erupted against President Bashar al-Assad almost two years ago. Despite an American program of nonlethal assistance to opponents of the Syrian government and $365 million in humanitarian aid, Mr. Obama appears to be running out of options to speed Mr. Assad’s exit.

With conditions continuing to deteriorate, officials said, the president could reopen the question of whether to provide weapons to select members of the resistance in an effort to break the impasse in Syria. The question is whether a wary Mr. Obama, surrounded by a new national security team, would come to a different conclusion.

“This is not a closed decision,” a senior administration official insisted. “As the situation evolves, as our confidence increases, we might revisit it.”

Mr. Obama’s refusal to provide arms when the proposal was broached before the November election, officials said, was driven by his reluctance to get drawn into a proxy war and his fear that the weapons would end up in unreliable hands, where they could be used against civilians or Israeli and American interests.

As the United States struggles to formulate a policy, however, Mr. Assad has given no sign that he is ready to yield power, and the Syrian resistance is adamant that it will not negotiate a transition in which he has a role. Mr. Obama, in his State of the Union address, did not repeat his oft-stated confidence that Mr. Assad’s days are numbered.

Even if Mr. Assad was overthrown, the convulsion could fragment Syria along sectarian and ethnic lines, each supported by competing outside powers, said Paul Salem, who runs the Beirut-based Middle East office for the Carnegie Endowment for International Peace. “Syria,” he said, “is in the process, not of transitioning, but disintegrating.”

The State Department has funneled $50 million of nonlethal assistance to the Syrian opposition, including satellite telephones, radios, broadcasting equipment, computers, survival equipment and the training in how to use them. This support, officials say, has helped Syrians opposed to the Assad regime communicate with one another and the outside world, despite efforts by Syrian forces to target rebel communications using Iranian-supplied equipment. A Syria-wide FM radio network is to connect broadcasting operations in several cities in the next several days. The State Department has also helped train local councils in areas that have freed from the Syrian government’s control.

But the State Department does not provide non-lethal assistance to armed rebel factions. This has greatly limited the influence the United States has with armed groups that are likely to control much of Syria if Mr. Assad is ousted..

“The odds are very high that, for better or worse, armed men will determine Syria’s course for the foreseeable future,” said Frederic C. Hof, a former senior State Department official and a senior fellow at the Atlantic Council. “For the U.S. not to have close, supportive relationships with armed elements, carefully vetted, is very risky.”

Because units of the anti-Assad Free Syria Army have captured prisoners and detained criminals in the areas they control, Mr. Hof said, it is essential that either the United States or an ally train rebel staff officers in judicial procedures and sensitive them to human rights concerns.

While the White House has focused on the risks of providing weapons, other nations have had no such reservations. Russia has continued to provide arms and financial support to the Assad government. Iran has supplied the regime with weapons and Quds Force advisers. Hezbollah has sent militants to Syria to help Mr. Assad’s forces. On the other side of the struggle, anti-government Qaeda-affiliated fighters have been receiving financial and other support from their backers in the Middle East.

The arming plan that was considered last year originated with David H. Petreaus, then the director of the Central Intelligence Agency, and was supported by former Secretary of State Hillary Rodham Clinton. The goal was to create allies in Syria with whom the United States could work during the conflict and if Mr. Assad was removed from power. Each had their reasons for supporting it.

Read More..

Mindy McCready: Under Police Scrutiny at Time of Suicide?

By Steve Helling and Mike Fleeman

02/18/2013 at 06:00 PM EST

Mindy McCready and David Wilson

Courtesy Mindy McCready

When Mindy McCready talked to police in recent weeks, her account of how her boyfriend came to be found with a fatal gunshot wound to the head concerned police, a law enforcement source tells PEOPLE.

"At first, she said she hadn't heard the gunshot because the TV was too loud. Then she said she had heard the gunshot," the source says. "So obviously there were a lot of questions, and the Sheriff was asking for clarification."

But before investigators could re-interview her, the long-troubled country singer also would die under eerily similar circumstances, her body discovered at the same Heber Springs, Ark., house just feet away from where David Wilson died.

McCready's death was blamed on what "appears to be a single self-inflicted gunshot wound," the Cleburne County Sheriff's Office said in a statement.

This differed from how the sheriff characterized Wilson's case. His cause and manner of death still have not been established by the coroner. It was McCready's publicist, and not a law enforcement official, who announced that Wilson had died of a self-inflicted gunshot wound.

After Wilson's death, McCready, 37, spoke to investigators three times, but they didn't feel as if they were through with her.

"At no point did [police] tell her she was a suspect, and she wasn't officially one," says the source. "But she knew that some of her answers didn't stand up to questioning. She was very cooperative, but she just wasn't making a lot of sense."

Read More..

Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

____

Online:

Pediatrics: http://www.pediatrics.org

___

Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

Read More..

Attorney killed wife on Italian cruise for her money, police say

A former Orange County attorney allegedly killed his ex-wife for financial gain in 2006 by strangling her and throwing her overboard while on a cruise along the Italian coast, authorities said.

Lonnie Kocontes, 55, a former Mission Viejo resident, was arrested Friday at his home in Safety Harbor, Fla., in connection with the death of his former wife, Micki Kanesaki, 52, of Ladera Ranch, authorities said. He is charged with one felony count of special circumstances for financial gain.

If convicted, he faces a maximum life sentence in state prison without the possibility of parole and is eligible for the death penalty, authorities said. Kocontes, who is being held without bail, also faces extradition proceedings at a date to be determined.

He is accused of financially benefiting from Kanesaki’s death because he was the beneficiary of several of their bank accounts and property and was receiving the proceeds from the sale of their home, authorities said.

The couple divorced in 2001 and were in the midst of a court battle when they decided to put aside their rancor and take a Mediterranean vacation together.

Kocontes is suspected of killing his wife on the night of May 25, 2006, or the morning of May 26, by strangling her and throwing her body overboard, authorities said.

At the time, Kocontes reported his wife missing. He told authorities that the couple had retired to bed when about 1 a.m. Kanesaki stepped out to get a cup of tea to help her relax and never returned.

Her body was found on the morning of May 27 by the Italian coast guard, floating in the sea near Reggio di Calabria.

"I wish I knew what happened," Kocontes was quoted as saying at the time. He told authorities that his former wife had previously talked of suicide.

But an autopsy revealed Kanesaki had been strangled, authorities said.

In 2008, Kocontes is accused of attempting to transfer $1 million between various banks accounts with his new wife, Katherine, authorities said. The FBI began investigating the money transfers for possible illegal activity and the U.S. attorney’s office ultimately seized the money from Kocontes’ bank account.

The Orange County district attorney’s office was contacted and subsequently the Sheriff’s Department relaunched its investigation, authorities said.

On Wednesday, the district attorney filed its murder case against Kocontes.      

The FBI and the Orange County Sheriff's Department are continuing the investigation.

ALSO:

Riverside officer wounded in Dorner manhunt is identified

Coliseum sues ex-auditor, alleging failure to detect corruption

LAPD's 'protection details' end after Dorner's remains identified

-- Andrew Blankstein

Read More..

Protests at Egypt Port Close Offices, but Not Suez Canal

CAIRO — Thousands of demonstrators shut down the administrative buildings of the Suez Canal terminal in the city of Port Said on Sunday, as part of a general strike protesting the death sentences handed down three weeks ago to 21 local soccer fans for their roles in a deadly riot last year.

The protests marked the closest that the chaos in Egypt over the last two years has come to threatening the operations of the Suez Canal, an artery of shipping critical to both international commerce and the battered Egyptian economy.

The administrative facilities were emptied as the protesters approached, residents said, but a military guard protected the port from disruption. President Mohamed Morsi, of the Muslim Brotherhood’s political arm, had deployed the military to protect the city when the protests there started three weeks ago.

The success of the strike, as life had begun to return to the streets, was a vivid reminder that the government in Cairo has not yet restored full control over Port Said, a major city at the Mediterranean head of the Suez Canal with a population of about 600,000. The government essentially backed down from its attempt to impose a curfew, and nothing has diminished the underlying anger behind the riots, first over the initial death sentences and then over the deaths of dozens of protesters in clashes with the police.

The possibility of a threat to the flow of traffic through the canal remains remote, but the Sunday protest raised the specter of such disruption at a critical time. Political turbulence has cut deeply into tourism and economic growth in the two years since the ouster of Hosni Mubarak. And now the political instability keeps delaying a proposed $4.8 billion loan from the International Monetary Fund, whose seal of approval is essential to obtaining the further billions in loans needed to close the country’s deficit.

The Egyptian pound is falling sharply against the dollar. Unemployment is high and prices are rising. The Suez Canal is one of Egypt’s main sources of hard currency, along with tourism, foreign aid, and remittances from Egyptians abroad.

The protest was also a rare example of major civil disobedience in Egypt since the revolution that overthrew Mr. Mubarak in early 2011. It was the first day of the work week here, and Egyptian state media and residents of Port Said said that demonstrators had gathered outside the provincial headquarters at 7 a.m., blocking access to the building.

The protesters urged employees of the provincial government, the court house, the telephone and natural gas utilities, customs offices and other government institutions to quit work and join their strike. Many did, the Web site of the state newspaper Al Ahram reported. Protesters blocked railways. Photographs that circulated on the Internet showed women sitting on desks they had dragged outside in a shutdown of a school, although residents said some schools and courts remained opened.

Al Ahram reported that the demonstrators were demanding legal action against police officers who had killed protesters during last month’s clashes. They also sought a review by a “neutral court” of the death sentences against the local soccer fans delivered in Cairo. The soccer brawl in the case took place at a match between bitter rivals, El Masry of Port Said and Al Ahly of Cairo, both of which have large followings of violent hard-core fans. Many residents of Port Said say they believe the sentencing judge succumbed to pressure from violent Cairo soccer fans who demanded retribution.

Read More..

Josh Kelley Dotes on Daughters Naleigh and Adalaide on Twitter

By Maggie Coughlan

02/17/2013 at 05:35 PM EST

Naleigh, Josh Kelley and Adalaide

Courtesy of Josh Kelley

Daddy's girls!

Proud papa Josh Kelley shared a photo of himself relaxing on the couch with daughters Naleigh, 4, and Adalaide, 9 months, on Twitter Saturday.

Posing with his arms around the girls, Kelley Tweeted, "I love my little chickadees. Everyone keeps saying it goes by so fast so I'm gonna soak it up!!"

This isn't the first time the husband to Katherine Heigl has doted on his daughters via Twitter.

On Feb. 6, he Tweeted he had gone golfing with Naleigh – who sported a panda hat to the green.

"Naleigh hitting golf balls with daddy rocking her panda bear ski hat. She's a nut if I've ever seen one!!!"

Read More..

UN warns risk of hepatitis E in S. Sudan grows

GENEVA (AP) — The United Nations says an outbreak of hepatitis E has killed 111 refugees in camps in South Sudan since July, and has become endemic in the region.

U.N. refugee agency spokesman Adrian Edwards says the influx of people to the camps from neighboring Sudan is believed to be one of the factors in the rapid spread of the contagious, life-threatening inflammatory viral disease of the liver.

Edwards said Friday that the camps have been hit by 6,017 cases of hepatitis E, which is spread through contaminated food and water.

He says the largest number of cases and suspected cases is in the Yusuf Batil camp in Upper Nile state, which houses 37,229 refugees fleeing fighting between rebels and the Sudanese government.

Read More..

Christopher Dorner supporters organize on Facebook

Several days after Christopher Dorner's death ended his standoff with authorities, some sympathizers have been expressing support for him online and on the street.

Dorner -- accused of the slayings of four people -- has gained some
supporters on the Web who have read his alleged manifesto and believe
its claims that he was unfairly fired by the Los Angeles Police
Department and was a victim of
racism.

Dozens of protesters gathered outside LAPD headquarters in downtown L.A. on Saturday afternoon in an event they said was organized through a
Facebook page called “I support Christopher Jordan Dorner.” The post announcing the protest advised attendees to “keep it PEACEFUL” and
to bring recording equipment.

PHOTOS: Manhunt for ex-LAPD officer

The Facebook page states: “This is not a page about supporting the
killing of innocent people. It’s supporting fighting back against
corrupt cops and bringing to light what they do.”

Those gathered Saturday said they were protesting police corruption and the
way the massive manhunt for Dorner was conducted. Authorities said
Dorner appears to have died from a self-inflected gunshot wound after a
shootout with police in Big Bear on Tuesday, ending a deadly rampage
that stretched across Southern California.

Protesters also said they were appalled by police officers' mistakenly shooting
at passengers in two separate trucks in Torrance, wrongly believing
Dorner might be in the vehicles. One woman was shot in the back and is
still recovering.

FULL COVERAGE: Sweeping manhunt for ex-cop

The protesters emphasized that they did not condone the killings of which Dorner is accused.

Michael Nam, 30, stood at the corner of 1st and Main Streets with a
sign, painted by his girlfriend, showing a tombstone and the words “RIP
Habeas Corpus.” The tombstone was engulfed in flames.

Nam, of Lomita, said he was disturbed by the burning of a mountain
cabin near Big Bear where Dorner barricaded himself with a high-powered
sniper rifle, smoke bombs and a cache of ammo. The blaze started shortly
after police fired "pyrotechnic" tear gas into the cabin; the canisters
are known as "burners" because the intense heat they emit often causes a
fire.

WHO THEY WERE: Victims in the Dorner case

But authorities have maintained that the fire was not intentionally set. 

Dorner, whose charred body was found in the cabin, appears to have died of a single gunshot wound to the head, authorities said.

“How the police handled this -– they were the judge, the jury and the
executioner,” Nam said. “As an American citizen, you have the right to a
trial and due process by law.”

TIMELINE: Manhunt for ex-LAPD officer

Nam, a former Marine and a current member of the Army National Guard,
said he has combat experience from deployments in Iraq and Afghanistan.

He said he has been in situations in which a combatant has been
barricaded and successfully waited until the person surrendered,
eventually getting “tired and coming out on their own.”

Nam said it was “pretty obvious” police wanted Dorner dead. “What I
saw was a complete disregard for the Bill of Rights,” Nam said.

San Bernardino County Sheriff John McMahon, during a news conference
Friday, defended the tactics used by his agency in the shootout at the
mountain cabin, which left one of his deputies dead and another
seriously wounded.

“The bottom line is the deputy sheriffs of this department, and the
law enforcement officers from the surrounding area, did an outstanding
job,” he said. “They ran into the line of fire.”

As the protesters stood Saturday, drivers passing by honked, waved
and gave thumbs up. A handful of officers watched from police
headquarters across the street.

Nam said he spoke to the officers before the protest began about what
the protesters should do to keep the event peaceful. He said the
officers were respectful.

The protesters marched around the block, circling an intersection
near the department headquarters. They chanted, “LAPD, you are guilty.”

Signs expressed anger at police and support for Dorner.

“If you’re not enraged, you’re not paying attention,” one sign read.

“Why couldn’t we hear his side?”

“Clear his name! Christopher Dorner”

Liliana Alaniz, 40, came with her family -– her mother, sister,
nieces and daughters -– from Long Beach to join the protest, which she
said was her first.

“I really, really believe he was innocent in the firing case,” Alaniz said of Dorner.

Alaniz held a sign that read, “Trying to clear your name.”

Her daughter, Andrea Tovar, said Dorner “has his supporters.”

“Murder is never right, but neither is the law when it’s unjust,”
said Tovar, 18. She said police need to know they “can’t get away with
everything.”

ALSO:

Ex-mayor who gambled away $1 billion to pay restitution

Riverside officer wounded in Dorner manhunt is identified

Dorner probably died of self-inflicted gunshot, officials say

-- Hailey Branson-Potts

twitter.com/haileybranson

Photo: Protesters outside LAPD headquarters on Saturday. Credit: Irfan Khan / Los Angeles Times

Read More..