Q: My father was diagnosed with bladder cancer. What is his prognosis?
A: Bladder cancer is the most common cancer of the urinary system, affecting over 70,000 Americans a year. In countries where the urinary form of schistosomiasis (a parasitic disease) is prevalent, the most common type of bladder cancer is squamous cell carcinoma, accounting for 75 percent of cases. However, more than 90 percent of bladder cancers in the U.S. are transitional cell cancers, and over 80 percent of these are associated with environmental exposures, most commonly tobacco use but also exposure to certain chemicals.
The classic symptom of bladder cancer is painless hematuria (blood in the urine), typically throughout the entire urine stream and often intermittent (clearing and recurring).
Hematuria can cause irritation, so some patients have urgency, frequency and/or discomfort as well. However, less than 20 percent of people with gross hematuria have bladder cancer; most have no abnormality identified (60 percent), and many others are diagnosed with urine infections, interstitial cystitis, prostatitis, kidney stones or other kidney diseases.
The prognosis and recommended treatment for bladder cancer depend on whether it invades the muscles of the bladder and/or extends beyond the bladder or has distant metastases, and this is evaluated during staging of the extent of the disease.
The first step in staging is a cystourethroscopy, where a long tube-like instrument is inserted through the urethra to directly visualize the bladder (and ureters) and to remove any tumors (called transurethral resection of bladder tumors or TURBT). Microscopic evaluation of the tumor specimens, as well as the urine, is also done.
Examination of the regional lymph nodes (N0 is no nodes, N1 is only one diseased node within the pelvis, multiple diseased nodes within the pelvis is N2 and nodes outside the pelvis N3) and evaluation for more distant metastases (such as lung, liver and bone) are also part of disease staging. However, the main factor is whether the tumor is confined to just the bladder so TURBT may be curative, or if it has progressed outside the bladder.
Although 70 percent of new transitional cell bladder cancer cases are initially classified as Ta, Tis or T1, up to 40 percent of these are later reclassified. Over half of these will recur if managed only with TURBT, and up to a quarter of these will progress through to the muscular layer or beyond to adjacent tissue or even more distant metastases, hence adjuvant therapy with treatments directly into the bladder (intravesicular) is often recommended (depending on the details of the cell type and other specifics).
The intravesicular treatments may be chemotherapy or more commonly BCG (the same bacteria as in the tuberculosis vaccine) which is used to stimulate an immune reaction to help fight the cancer.
More invasive stages may be treated with complete removal of the bladder and any adjacent affected organs, as well as chemotherapy. Radiation therapy may also be considered, sometimes to shrink the tumor before resection or sometimes in addition to chemotherapy after resection. When the bladder is removed another method to evacuate the urine is needed, sometimes a tube to a bag outside the body, or sometimes construction of a "new" bladder using a piece of intestine.
Up to 80 percent of bladder cancer patients have at least one recurrence, even though the 5-year survival rate of Ta, TIS and T1 disease is over 80 percent. The 5-year survival drops as the extent of disease increases, with a 60 percent to 80 percent 5-year survival for T2 disease, a 20 percent to 70 percent (wide variability with other factors key to a specific patient's prognosis) for T3 disease, and a less than 20 percent survival for those with T4 disease.
Even though most hematuria patients do not have bladder cancer, since early diagnosis of bladder cancer can improve outcomes, all patients with hematuria should see their health care provider to be evaluated.
2011年4月12日星期二
The majority of these cases occur secondary to renal stones
Seventeen cases of peritonitis due to rupture of a pyonephrosis have been reported. The majority of these cases occur secondary to renal stones.
Only two cases of ruptured pyonephrosis with concurrent kidney neoplasm have been described and only one of these presented as an acute peritonitis. In this presentation we discuss an unusual case of a 68 year old man with a chronic history of bilateral nephrolithiasis and recent pyonephrosis.
He presented acutely with peritonitis and was later found to have a carcinosarcoma of the kidney. The case highlights the importance of recognizing the possibility of underling renal carcinoma in patients presenting with a ruptured pyonephrosis and discuss steps to avoid this serious complication.
Author: Silvia QuaresimaAntonio ManzelliEdoardo RicciardiAthanasios PetrouNicholas BrennanAlessandro MaurielloPiero Rossi.
Only two cases of ruptured pyonephrosis with concurrent kidney neoplasm have been described and only one of these presented as an acute peritonitis. In this presentation we discuss an unusual case of a 68 year old man with a chronic history of bilateral nephrolithiasis and recent pyonephrosis.
He presented acutely with peritonitis and was later found to have a carcinosarcoma of the kidney. The case highlights the importance of recognizing the possibility of underling renal carcinoma in patients presenting with a ruptured pyonephrosis and discuss steps to avoid this serious complication.
Author: Silvia QuaresimaAntonio ManzelliEdoardo RicciardiAthanasios PetrouNicholas BrennanAlessandro MaurielloPiero Rossi.
2011年4月10日星期日
Nitrate-tainted milk case in China deemed intentional poisoning
Intentional poisoning was behind the tainted milk that killed three children and caused 36 others to become ill in China's northwestern Gansu province last week, state media reported Sunday night, adding to the woes of the country's maligned dairy industry.
Local investigators in Pingliang city said they had arrested suspects in connection with the nitrate-laden milk that caused 39 people to seek hospital care last Thursday, Xinhua news agency said. It did not give details on the suspects' identities or motives.
Nitrate, which is used to cure meat, has no use as a milk additive, the official China Daily newspaper cited a health bureau official as saying.
The three children who died after consuming the tainted milk were all under two years old. As of Sunday, 17 of the victims remained hospitalised but were in stable condition.
China's food sector has suffered from frequent poisonings and toxin scandals, and the fast-growing but fragmented dairy sector has been at the heart of those worries.
Earlier this year, Chinese quality authorities sought to calm renewed public alarm after reports that some manufacturers had illegally added a leather protein powder to dairy products to cheat protein-content checks.
In 2008, at least six children died and nearly 300,000 became ill from powdered milk laced with melamine, an industrial chemical added to low quality or diluted milk to fool inspectors by giving misleadingly high readings for protein levels.
Local investigators in Pingliang city said they had arrested suspects in connection with the nitrate-laden milk that caused 39 people to seek hospital care last Thursday, Xinhua news agency said. It did not give details on the suspects' identities or motives.
Nitrate, which is used to cure meat, has no use as a milk additive, the official China Daily newspaper cited a health bureau official as saying.
The three children who died after consuming the tainted milk were all under two years old. As of Sunday, 17 of the victims remained hospitalised but were in stable condition.
China's food sector has suffered from frequent poisonings and toxin scandals, and the fast-growing but fragmented dairy sector has been at the heart of those worries.
Earlier this year, Chinese quality authorities sought to calm renewed public alarm after reports that some manufacturers had illegally added a leather protein powder to dairy products to cheat protein-content checks.
In 2008, at least six children died and nearly 300,000 became ill from powdered milk laced with melamine, an industrial chemical added to low quality or diluted milk to fool inspectors by giving misleadingly high readings for protein levels.
2011年4月7日星期四
Under this surreal 'rule by law', Ai Weiwei is guilty
When the Chinese foreign ministry spokesman Hong Lei insisted to reporters in Beijing this week that "China is a country ruled by law", and "other countries have no right to interfere" in the case of the detained avant-garde artist Ai Weiwei, there was a certain truth to his remarks. China is a country ruled by law. But this is quite different, as many victims of official corruption in China have discovered, from being a country in which the rule of law prevails.
The rule of law contains important principles: the law is supreme, and all have equal rights before it. The concept of rule by law was pioneered by one of China's harshest imperial regimes, the shortlived but influential Qin dynasty, 2,000 years ago. The Qin emperor saw the law as an instrument of authoritarian rule, to be defined and used as he chose, and it is this tradition that appeals to the current Chinese leadership.
Without understanding the distinction it is hard to see how China's growing body of law, with its court apparatus, judges and lawyers, really functions. Under a conventional system the supreme judicial authorities might be expected to have some legal background, but in China the head of the political and legal committee of the central committee of the Communist party, Luo Gan, is an engineer turned security supremo who is there to ensure the system serves the party. As he has put it, his role is to guard against "negative western legal concepts" like judicial independence.
The party controls the courts, appoints the judges and routinely dictates the verdicts. Even if a citizen wins a case, the court has little power to enforce the verdict without the backing of those same state officials. A Chinese litigant is often in the Kafkaesque situation of being dependent on those who committed the abuse for redress.
Nevertheless, with few other possibilities, growing numbers of Chinese citizens try to use the law to fight back against corruption. But if the citizen is expected to obey the law, the party state itself can shape and deploy it to suppress dissent and to preserve the careers of corrupt party officials. The party's discipline department will act against deviant officials when it wishes, but such matters are too important to be the concern of the legal system.
The law is, however, a handy means of detaining, harassing and disbarring defence lawyers who get in the way of the state, and for the prosecution of complaining citizens for ill-defined offences against public order, social stability, national security or, as in Ai Weiwei's case, economic crimes.
Ai's alleged economic crimes are bound to pale in comparison with those of state officials, who are reckoned to steal more than $80bn a year. A report by Beijing's Renmin University in 2005 estimated that 90% of Chinese officials spend more than they nominally earn, so if Ai's economic crimes do exist, they are unlikely to be the real problem.
Far more important are his stubborn efforts to document the names of those killed by official corruption. In this he has enjoyed more latitude than many: as the son of the celebrated revolutionary poet Ai Qing, he counts as one of China's new aristocracy. But when he set out to collect the names of the children who perished in the deathtraps of their badly-built schools in the 2008 Sichuan earthquake, he was treading on sensitive toes.
No official has been prosecuted for the corruption that produced those schools. Instead, the parents of the dead children have been harassed; a teacher who tried to help them has been jailed; and Ai Weiwei himself has suffered a brain haemorrhage from a beating last year in Sichuan. When 58 migrant workers died in a fire in a corruptly-built Shanghai tower block, Ai again set out to document the dead. This is not listed as a crime under Chinese law, but it certainly annoys those responsible.
Ai was not the first to test the limits of official tolerance. When corruption in the dairy industry led to the poisoning of a quarter of a million babies in 2008, the news was suppressed for several months so as not to spoil the Olympic mood. The firm responsible was prosecuted, but many complicit officials were not. Among the parents who remained vocally unhappy was Zhao Lianhai, who continued to campaign for compensation for his infant son, who developed kidney stones. He was sentenced to two-and-a-half years in jail. Another father, Guo Li, got a five-year sentence.
But punishing the victims for taking legal action against corrupt officials no longer seems to be enough. In recent months a series of detentions and disappearances of active lawyers has signalled a more robust attack on the exercise of legal rights. The most notorious case is that of Gao Zhisheng, a leading human rights lawyer who was given a three-year suspended sentence in 2006 for "inciting subversion" – and who disappeared last April.
The rule of law contains important principles: the law is supreme, and all have equal rights before it. The concept of rule by law was pioneered by one of China's harshest imperial regimes, the shortlived but influential Qin dynasty, 2,000 years ago. The Qin emperor saw the law as an instrument of authoritarian rule, to be defined and used as he chose, and it is this tradition that appeals to the current Chinese leadership.
Without understanding the distinction it is hard to see how China's growing body of law, with its court apparatus, judges and lawyers, really functions. Under a conventional system the supreme judicial authorities might be expected to have some legal background, but in China the head of the political and legal committee of the central committee of the Communist party, Luo Gan, is an engineer turned security supremo who is there to ensure the system serves the party. As he has put it, his role is to guard against "negative western legal concepts" like judicial independence.
The party controls the courts, appoints the judges and routinely dictates the verdicts. Even if a citizen wins a case, the court has little power to enforce the verdict without the backing of those same state officials. A Chinese litigant is often in the Kafkaesque situation of being dependent on those who committed the abuse for redress.
Nevertheless, with few other possibilities, growing numbers of Chinese citizens try to use the law to fight back against corruption. But if the citizen is expected to obey the law, the party state itself can shape and deploy it to suppress dissent and to preserve the careers of corrupt party officials. The party's discipline department will act against deviant officials when it wishes, but such matters are too important to be the concern of the legal system.
The law is, however, a handy means of detaining, harassing and disbarring defence lawyers who get in the way of the state, and for the prosecution of complaining citizens for ill-defined offences against public order, social stability, national security or, as in Ai Weiwei's case, economic crimes.
Ai's alleged economic crimes are bound to pale in comparison with those of state officials, who are reckoned to steal more than $80bn a year. A report by Beijing's Renmin University in 2005 estimated that 90% of Chinese officials spend more than they nominally earn, so if Ai's economic crimes do exist, they are unlikely to be the real problem.
Far more important are his stubborn efforts to document the names of those killed by official corruption. In this he has enjoyed more latitude than many: as the son of the celebrated revolutionary poet Ai Qing, he counts as one of China's new aristocracy. But when he set out to collect the names of the children who perished in the deathtraps of their badly-built schools in the 2008 Sichuan earthquake, he was treading on sensitive toes.
No official has been prosecuted for the corruption that produced those schools. Instead, the parents of the dead children have been harassed; a teacher who tried to help them has been jailed; and Ai Weiwei himself has suffered a brain haemorrhage from a beating last year in Sichuan. When 58 migrant workers died in a fire in a corruptly-built Shanghai tower block, Ai again set out to document the dead. This is not listed as a crime under Chinese law, but it certainly annoys those responsible.
Ai was not the first to test the limits of official tolerance. When corruption in the dairy industry led to the poisoning of a quarter of a million babies in 2008, the news was suppressed for several months so as not to spoil the Olympic mood. The firm responsible was prosecuted, but many complicit officials were not. Among the parents who remained vocally unhappy was Zhao Lianhai, who continued to campaign for compensation for his infant son, who developed kidney stones. He was sentenced to two-and-a-half years in jail. Another father, Guo Li, got a five-year sentence.
But punishing the victims for taking legal action against corrupt officials no longer seems to be enough. In recent months a series of detentions and disappearances of active lawyers has signalled a more robust attack on the exercise of legal rights. The most notorious case is that of Gao Zhisheng, a leading human rights lawyer who was given a three-year suspended sentence in 2006 for "inciting subversion" – and who disappeared last April.
2011年4月6日星期三
Sharks Gameday: Milestones, Stepping Stones & Kidney Stones
With the season coming to a close, the Sharks have three games to achieve the few things they haven't yet this season. These objectives vary in importance, but reaching any of the potential plateaus only helps to further set the table for the imminent postseason.
First, Sharks' Captain Joe Thornton is just a goal or an assist away from reaching the career milestone of 1,000 NHL points. Thornton has stated that breaking that barrier means little in the long-run; the Captain's eyes appear firmly affixed on the ultimate goal of playoff success. However, it would be nice if Thornton could grab his 1,000th point before the season ends, if only to avoid the unnecessary and equally predictable questions that would accompany a failure to do so. If Thornton has to wait until next season to get his 1,000th, you can be sure that it will be mentioned ad nauseum until the puck drops for the 2011-2012 season.
Thornton has always been one to receive undue blame for the teams' struggles, but it would be hard to criticize him after he just reached such an impressive career achievement. Well, at least until the Sharks drop a game in the playoffs. Then it's his fault again. The soothsayer in me predicts Thornton notches his 1,000th point tonight, coming off what else but his 695th career assist.
The other point(s) all should be paying attention to tonight are in the standings. With just three games left, the Sharks sit one point over Detroit in the West for second in the Conference. The Sharks control their own destiny here; three wins guarantees them the second seed. It likely won't take a 3-0-0 record to obtain that seeding; even so, maybe it's better... just to be safe. Home ice advantage against any team besides Vancouver is on the line, and that's an important an asset to have as any come playoff time.
Lastly, the Sharks can make a small statement if a different Joe lights the lamp. If Joe Pavelski scores a goal before the season's end, it would give the Sharks seven twenty-goal scorers for the first time in the franchises' twenty-year history. No, that accomplishment doesn't mean much in the long run; the regular season slate is wiped clean as soon as the first round begins. Still, the scoring depth displayed by San Jose this year is astounding, further evidence of the idea that this bunch of players may be different than those which have failed in years past.
Star-divide
If they truly are different, though, the Sharks will continue to keep their collective foot on the necks of their Pacific Division foes. The division title may be locked up, but the playoff picture remains far from certain. Anaheim, who looked like a veritable lock for the tournament just a week ago, is hanging on by a thread. Just two points separate the Ducks from Dallas and Calgary, the ninth and tenth seeds in the conference. They've now lost two in a row coming into tonight's match, and a prolonged losing stretch could send them to the golf course sooner than ever expected.
As such, Anaheim will likely come out swinging against San Jose. Not only do they need the two points desperately, but its likely that the Ducks will glean some extra motivation from their most recent loss in San Jose. Anaheim didn't just blow a two-goal lead in the contest, but they also were the victims of an unfortunate injury to Norris candidate Lubomir Visnovsky. Visnovsky is playing again, but that will likely do little to quell the anger displayed by his teammates, and more specifically, his coach Randy Carlyle. Carlyle, who made some lewd gestures involving a certain finger on the middle of ones hand to go with some sailor's vocabulary, should have no trouble penning some inspirational words on the team board before the game. His squad will be ready to fight, and make no mistake, the Ducks are still a scary bunch.
The Sharks have had little trouble dealing with fight lately, though. Over the course of the last month, and more specifically the last four games, San Jose has made quick work of teams battling for a playoff spot. Doing so again tonight would be even more proof that this team is ready foe whatever comes their way.
First, Sharks' Captain Joe Thornton is just a goal or an assist away from reaching the career milestone of 1,000 NHL points. Thornton has stated that breaking that barrier means little in the long-run; the Captain's eyes appear firmly affixed on the ultimate goal of playoff success. However, it would be nice if Thornton could grab his 1,000th point before the season ends, if only to avoid the unnecessary and equally predictable questions that would accompany a failure to do so. If Thornton has to wait until next season to get his 1,000th, you can be sure that it will be mentioned ad nauseum until the puck drops for the 2011-2012 season.
Thornton has always been one to receive undue blame for the teams' struggles, but it would be hard to criticize him after he just reached such an impressive career achievement. Well, at least until the Sharks drop a game in the playoffs. Then it's his fault again. The soothsayer in me predicts Thornton notches his 1,000th point tonight, coming off what else but his 695th career assist.
The other point(s) all should be paying attention to tonight are in the standings. With just three games left, the Sharks sit one point over Detroit in the West for second in the Conference. The Sharks control their own destiny here; three wins guarantees them the second seed. It likely won't take a 3-0-0 record to obtain that seeding; even so, maybe it's better... just to be safe. Home ice advantage against any team besides Vancouver is on the line, and that's an important an asset to have as any come playoff time.
Lastly, the Sharks can make a small statement if a different Joe lights the lamp. If Joe Pavelski scores a goal before the season's end, it would give the Sharks seven twenty-goal scorers for the first time in the franchises' twenty-year history. No, that accomplishment doesn't mean much in the long run; the regular season slate is wiped clean as soon as the first round begins. Still, the scoring depth displayed by San Jose this year is astounding, further evidence of the idea that this bunch of players may be different than those which have failed in years past.
Star-divide
If they truly are different, though, the Sharks will continue to keep their collective foot on the necks of their Pacific Division foes. The division title may be locked up, but the playoff picture remains far from certain. Anaheim, who looked like a veritable lock for the tournament just a week ago, is hanging on by a thread. Just two points separate the Ducks from Dallas and Calgary, the ninth and tenth seeds in the conference. They've now lost two in a row coming into tonight's match, and a prolonged losing stretch could send them to the golf course sooner than ever expected.
As such, Anaheim will likely come out swinging against San Jose. Not only do they need the two points desperately, but its likely that the Ducks will glean some extra motivation from their most recent loss in San Jose. Anaheim didn't just blow a two-goal lead in the contest, but they also were the victims of an unfortunate injury to Norris candidate Lubomir Visnovsky. Visnovsky is playing again, but that will likely do little to quell the anger displayed by his teammates, and more specifically, his coach Randy Carlyle. Carlyle, who made some lewd gestures involving a certain finger on the middle of ones hand to go with some sailor's vocabulary, should have no trouble penning some inspirational words on the team board before the game. His squad will be ready to fight, and make no mistake, the Ducks are still a scary bunch.
The Sharks have had little trouble dealing with fight lately, though. Over the course of the last month, and more specifically the last four games, San Jose has made quick work of teams battling for a playoff spot. Doing so again tonight would be even more proof that this team is ready foe whatever comes their way.
2011年4月5日星期二
Indian docs remove kidney stones from Iraqi man
New Delhi, April 5 (IANS) Iraqi shopkeeper Naeem Musa had braced for a long, painful treatment for stones in both kidneys, as two earlier operations were not of much help. He had not imagined that a minimally invasive surgery at a private hospital in Delhi will cure his decade-old ailment.
Musa, 46, was told to go for a third major surgery by doctors back home. After a shooting pain, his family decided to bring him to Delhi, where doctors removed the multiple stones by a surgical technique called Percutaneous Nephrolithotomy (PCNL).
'When the patient came to us, we observed it was a serious stag-horn case where there are multiple stones in the entire kidney. One of his kidneys was damaged, while there were cuts on both the kidneys as they had already gone through two open surgeries in Iraq,' Anshuman Agarwal, senior consultant urologist at Fortis Hospital in Vasant Kunj, told IANS.
'It required a bilateral stone surgery. The kidneys had been operated upon before also, and any major surgery could have been fatal,' he added.
PCNL, a minimally invasive endoscopic treatment, makes a small incision in the back, opposite the kidney, to make way for a nephroscope that locates the exact position of the stones.
Agarwal explains: 'Three small incisions were made in this case. A nephroscope was then used to locate the existing stones that were 1-12 cm in radius. There were some residual stones that could not be taken out in the previous surgery.'
PCNL, believe experts, minimises the hospital stay of the patient with quick recovery, and is preferable to open surgery.
Musa, who was admitted to the hospital March 23, was discharged in just five days and went back to his hometown of Kirkuk.
The surgery costs around Rs.1 lakh ($2,250) in India, 10 times less than the cost in the US and European nations, said Agarwal.
According to health experts, the technique, common in metros, will help an increasing number of patients in Tier-II and III cities in the coming time.
'People will be more aware of the PCNL technique in the coming period. Till now, only a few ways of treating kidney stones were available, but this method is beneficial for serious cases of multiple stones,' Sandeep Mahajan, additional professor, department of nephrology at the All India Institute of Medical Sciences (AIIMS), told IANS.
Mahajan sounds a note of caution on the dietary habits and changing lifestyle pattern that puts people at greater risk of kidney stones.
'These stones are calcium deposits, so they are largely dependent on what kind of food is there in a person's diet. Less fluids, red meat, high salt intake, nuts, chocolates are just some of the factors for forming kidney stones,' he said.
People with a hereditary history of stones too are at a greater risk of the disease, he said.
'Pain in the lower abdomen, fever or signs of blood in the urine, deep-orange tinge in the urine, or pain while urination should be reported to a doctor,' Mahajan added.
Musa, 46, was told to go for a third major surgery by doctors back home. After a shooting pain, his family decided to bring him to Delhi, where doctors removed the multiple stones by a surgical technique called Percutaneous Nephrolithotomy (PCNL).
'When the patient came to us, we observed it was a serious stag-horn case where there are multiple stones in the entire kidney. One of his kidneys was damaged, while there were cuts on both the kidneys as they had already gone through two open surgeries in Iraq,' Anshuman Agarwal, senior consultant urologist at Fortis Hospital in Vasant Kunj, told IANS.
'It required a bilateral stone surgery. The kidneys had been operated upon before also, and any major surgery could have been fatal,' he added.
PCNL, a minimally invasive endoscopic treatment, makes a small incision in the back, opposite the kidney, to make way for a nephroscope that locates the exact position of the stones.
Agarwal explains: 'Three small incisions were made in this case. A nephroscope was then used to locate the existing stones that were 1-12 cm in radius. There were some residual stones that could not be taken out in the previous surgery.'
PCNL, believe experts, minimises the hospital stay of the patient with quick recovery, and is preferable to open surgery.
Musa, who was admitted to the hospital March 23, was discharged in just five days and went back to his hometown of Kirkuk.
The surgery costs around Rs.1 lakh ($2,250) in India, 10 times less than the cost in the US and European nations, said Agarwal.
According to health experts, the technique, common in metros, will help an increasing number of patients in Tier-II and III cities in the coming time.
'People will be more aware of the PCNL technique in the coming period. Till now, only a few ways of treating kidney stones were available, but this method is beneficial for serious cases of multiple stones,' Sandeep Mahajan, additional professor, department of nephrology at the All India Institute of Medical Sciences (AIIMS), told IANS.
Mahajan sounds a note of caution on the dietary habits and changing lifestyle pattern that puts people at greater risk of kidney stones.
'These stones are calcium deposits, so they are largely dependent on what kind of food is there in a person's diet. Less fluids, red meat, high salt intake, nuts, chocolates are just some of the factors for forming kidney stones,' he said.
People with a hereditary history of stones too are at a greater risk of the disease, he said.
'Pain in the lower abdomen, fever or signs of blood in the urine, deep-orange tinge in the urine, or pain while urination should be reported to a doctor,' Mahajan added.
2011年4月1日星期五
TCI Journal editors take strong issue with comments made by NHIB CEO Brian Hogan in SUN interview
In an exclusive interview given to SUN publisher Hayden Boyce, CEO of the National Health Insurance Plan, NHIP, Brian Hogan issues forth a merciless stream of untruths. In particular we would like to draw the attention of all TCI citizens and residents to his attempt to paint as an example of exemplary care, the care given to a woman who as a result of NHIP actions and inactions, lost one of her kidneys and who but for the grace of others, almost lost her life!
There are so many untruths, half truths and patent lies in Brian Hogan's statements to Hayden Boyce, that one hardly knows where to begin.
But let us try and set the record straight. We quote from the article (in italics) and then the facts. Considering that Dayna Wallace, Brian Hogan's protege was fired (by the NHIB against his objections) from her position as NHIP Operations Manager especially because of her mis-handling of this case among many others, it is astonishing (and frankly goes to his state of mind) that Brian Hogan would EVEN DARE attempt to mislead the public on this case!
And Governor Wetherell, if you do not have time to read the whole piece, please at least read the conclusion at the end. From the March 25th Sun article titled : NHIB not responsible for any patient deaths or inadequate health care, says CEO Brian Hogan.
He said: "Last summer, a website reported that a beneficiary required emergency medical treatment at an offshore facility. It stated that an air ambulance vendor was not able to evacuate the patient until the following day when it transferred the patient to a regional medical facility rather than a facility in the USA. The patient was then provided travel by a third party to a facility in South Florida which was forced to perform emergency service due to the delays of the original transfer and the poor care at the regional medical facility."
[The Truth: We said much more than this. In particular the 30 days of negligence and multiple incidents in reference to this patient preceding this one event that Brian Hogan mentions above.]
He continued: "The reality is that a beneficiary, a national of a country in the region was referred to an overseas facility after an on-island specialist diagnosed her condition and recommended a second opinion and surgery if the diagnosis was confirmed.
[The Truth: A Turks and Caicos Islander was diagnosed and recommended to go to the United States within 24 hours for a serious kidney stone issue. A doctor at Interhealth Canada communicated with a doctor in the US and exchanged details about the patient……..then when care was still not provided after ONE MONTH had elapsed, other TCI medical personnel intervened out of concern to draw attention to the patient. Only then was she sent to the Bahamas on Brian Hogan's favoured air ambulance company.………….Redbridge Networks, the company hired by Hogan to handle overseas treatment had NO qualified medical director and was not monitoring this case for some unknown reason, and the previous firm who used to handle these matters for the TCI had been black-listed by Hogan for having blown the whistle on NHIP mis-management…………. In the Bahamas the PATIENT & THE BAHAMIAN MEDICAL STAFF called the previous firm since the patient had been abandoned in the Bahamas with no follow-up from NHIP operations personnel for over a week after being sent there!]
There are so many untruths, half truths and patent lies in Brian Hogan's statements to Hayden Boyce, that one hardly knows where to begin.
But let us try and set the record straight. We quote from the article (in italics) and then the facts. Considering that Dayna Wallace, Brian Hogan's protege was fired (by the NHIB against his objections) from her position as NHIP Operations Manager especially because of her mis-handling of this case among many others, it is astonishing (and frankly goes to his state of mind) that Brian Hogan would EVEN DARE attempt to mislead the public on this case!
And Governor Wetherell, if you do not have time to read the whole piece, please at least read the conclusion at the end. From the March 25th Sun article titled : NHIB not responsible for any patient deaths or inadequate health care, says CEO Brian Hogan.
He said: "Last summer, a website reported that a beneficiary required emergency medical treatment at an offshore facility. It stated that an air ambulance vendor was not able to evacuate the patient until the following day when it transferred the patient to a regional medical facility rather than a facility in the USA. The patient was then provided travel by a third party to a facility in South Florida which was forced to perform emergency service due to the delays of the original transfer and the poor care at the regional medical facility."
[The Truth: We said much more than this. In particular the 30 days of negligence and multiple incidents in reference to this patient preceding this one event that Brian Hogan mentions above.]
He continued: "The reality is that a beneficiary, a national of a country in the region was referred to an overseas facility after an on-island specialist diagnosed her condition and recommended a second opinion and surgery if the diagnosis was confirmed.
[The Truth: A Turks and Caicos Islander was diagnosed and recommended to go to the United States within 24 hours for a serious kidney stone issue. A doctor at Interhealth Canada communicated with a doctor in the US and exchanged details about the patient……..then when care was still not provided after ONE MONTH had elapsed, other TCI medical personnel intervened out of concern to draw attention to the patient. Only then was she sent to the Bahamas on Brian Hogan's favoured air ambulance company.………….Redbridge Networks, the company hired by Hogan to handle overseas treatment had NO qualified medical director and was not monitoring this case for some unknown reason, and the previous firm who used to handle these matters for the TCI had been black-listed by Hogan for having blown the whistle on NHIP mis-management…………. In the Bahamas the PATIENT & THE BAHAMIAN MEDICAL STAFF called the previous firm since the patient had been abandoned in the Bahamas with no follow-up from NHIP operations personnel for over a week after being sent there!]
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