The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
March 17, 2003

 

 

 

Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

Personal Health for the Week of January 18-24

  1. New Breast Cancer Gene Discovered

 

FRIDAY, JANUARY 24, 2003 

Transplant Drug May Fight Lupus, Cancer 

HealthScoutNews

Friday, January 24, 2003

FRIDAY, Jan. 24 (HealthScoutNews) -- The drug Rapamycin, used to prevent organ rejection in kidney transplant patients, may also help people with lupus and some cancers, says a study in the journal Blood.

Rapamycin, like many anti-rejection drugs, suppresses immune T-cells. In this study, American and German researchers found the drug also inhibits the function and activation of dendritic cells.

These are cells that play a much earlier role in immune response because they're the first to identify foreign intruders in the body. The dendritic cells then present these intruders to other immune system cells, including T-cells.

Dendritic cells play an important role in conditions such as atherosclerosis and a number of autoimmune diseases, such as lupus, where dendritic cells create constant immune system responses.

The study also found Rapamycin disarms the trigger that allows the proliferation of dendritic cells. This trigger is a potent, naturally occurring growth factor. It also affects the proliferation of blood precursors and stem cells which, when unchecked, result in leukemia and other cancers.

More information

Here's where you can learn more about lupus.

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Double Hand Transpant Patient Doing Well

 

The Associated Press

Friday, January 24, 2003

LYON, France - A French man who received the world's first double hand transplant three years ago says he can shave, use a fork and punch the buttons on his cell phone.

At a news conference Friday to explain his progress, Denis Chatelier said he has regained normal use of his hands.

"I can eat with a fork, use my cell phone and shave," said Chatelier, 36, who still has two hours of physical therapy a day. "Little by little, I have regained the movements that I had forgotten."

Chatelier's forearms were severed in 1996 when a handmade model rocket he was trying to launch exploded before takeoff. In January 2000, the former marathon runner underwent a 17-hour transplant surgery at the Edouard Herriot hospital in Lyon.

Eighteen top surgeons, urgently assembled from across the world after a donor was found, operated on Chatelier, attaching arteries, veins, nerves, tendons and muscles, as well as setting the new bones.

The identity of the donor was not made public.

"Denis' progress was well beyond our expectations," Dr. Jean-Michel Dubernard said.

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Parkinson's Drug May Help Smokers Quit

 

Reuters Health

Friday, January 24, 2003

NEW YORK (Reuters Health) - A drug used to treat Parkinson's disease (news - web sites) may help some people quit smoking, the results of a small, preliminary study suggest.

The drug, selegiline, acts by delaying the breakdown of dopamine, the chemical that progressively diminishes in parts of the brain as Parkinson's disease advances.

"There is increasing evidence for a role of dopamine systems in the neurobiology of nicotine dependence," Dr. Tony P. George and colleagues write in the January issue of the journal Biological Psychology.

In the study, George's team evaluated the number of patients who quit smoking while taking selegiline and assessed any adverse side effects of the drug.

For eight weeks, 20 patients took selegiline and 20 took an inactive placebo. At the end of the eight-week period, 9 of the 20, or 45%, who took selegiline had quit smoking. Six months later, four people were cigarette-free, the study indicates.

By comparison, only 15% of those taking a placebo had stopped smoking by the end of eight weeks. Only one person was cigarette-free at six months, the authors report.

Among those taking selegiline, side effects were "generally mild" and included loss of appetite, gastrointestinal symptoms and insomnia, the authors report.

Given the very small number of people in the study, the authors recommend that further studies be conducted to see if selegiline can indeed help people quit smoking.

"While there are several effective treatments for smoking cessation, including nicotine replacement therapies and bupropion (Zyban), there are many smokers who do not respond to these drugs," said George, who is with the Yale University School of Medicine in New Haven, Connecticut, in a prepared statement.

"So developing new drugs for smoking cessation is an important undertaking. Selegiline (Deprenyl) appears to be a drug that might have promise for treatment of nicotine addiction," George concluded.

The study was funded by grants from the National Institute on Drug Abuse, the National Cancer Institute (news - web sites) and the Robert Wood Johnson Foundation.

Source: Biological Psychology 2003:53:136-143.

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New Weapon Against Listeria

HealthScoutNews

Friday, January 24, 2003

THURSDAY, Jan. 23 (HealthScoutNews) -- A new kind of chemical treatment may help kill Listeria monocytogenes and make it safer for you to eat lunch meats, hot dogs, smoked fish and some kinds of soft cheeses.

Texas A&M University researchers say a new product called acidified calcium sulfate shows promise in decontaminating the surface of cooked food products. They say it not only kills Listeria that may be present on food; it also prevents the bacteria from coming back.

They tested it on frankfurters that contained high levels of Listeria.

The product could offer meat processors another way to increase the safety of their products, and several want to test acidified calcium sulfate on their own products.

Listeria can grow at refrigerator temperatures and is considered a serious health threat. It doesn't affect many people, but it can be deadly. It can cause flu-like symptoms, meningitis, spontaneous abortions and prenatal septicemia. About 20 percent of listeriosis cases are fatal.

Processed food products can be contaminated by Listeria that comes from the environment or from employees in meat-processing plants.

More information

Here's where to learn more about Listeria.

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Women Often Start Smoking Again After Pregnancy

 

By Charnicia E. Huggins

Reuters Health

Friday, January 24, 2003

NEW YORK (Reuters Health) - Many women who successfully kick the smoking habit during pregnancy pick it back up after they give birth, new study findings show.

"We think this is an opportunity lost for those concerned with public health because studies show that the longer a person is away from cigarettes, the less likely she is to resume," Dr. Gregory J. Colman of Pace University in New York told Reuters Health.

"Perhaps health professionals should increase their efforts to keep women off cigarettes during this post-natal period, when these efforts are most likely to be rewarded," he added.

The findings are based on 1993 to 1999 surveys of 115,000 new mothers from 10 US states.

During the past decade, smoking has declined both among pregnant women and among women of reproductive age, note Colman and his co-author Dr. Ted Joyce, of City University of New York.

The reason for this decline, the authors suggest, could be due in part to the increased number of anti-smoking campaigns that target pregnant women, the flurry of media attention surrounding the recent tobacco settlement between tobacco companies and 46 states, and increasing cigarette prices.

In the current study, roughly one in four women reported smoking three months before pregnancy, but the proportion of women who reported quitting during pregnancy jumped from 37% in 1993 to 46% in 1999.

In fact, pregnant women were 51% more likely to quit smoking in 1999 than in 1993, the researchers report in the January issue of the American Journal of Preventive Medicine.

Still, about half of the women who quit smoking during pregnancy picked the habit back up within six months of giving birth.

Black women, college-educated women, those with private insurance, and first-time mothers were least likely to resume the habit than were their counterparts. Teenagers, on the other hand, who were more likely to quit than older women, were also more likely to start lighting up again after pregnancy.

Finally, women who smoked ten or fewer cigarettes each day before becoming pregnant were more likely to quit smoking before delivery than heavy smokers. Heavy smokers who did quit smoking during pregnancy were more likely to resume smoking after delivery, the report indicates.

"This suggests that if someone plans to quit during pregnancy, she is more likely to be successful if she starts cutting down well before she becomes pregnant," Colman said.

Yet despite their findings, Colman and Joyce say they "cannot dismiss the possibility" that women under-reported their smoking during pregnancy or over-reported their quit rates due to the stigma surrounding the practice.

"There may be less stigma associated with smoking before pregnancy and after delivery, especially if the baby is healthy," they write.

To decrease smoking after delivery, Colman recommends that health officials emphasize to pregnant women "that smoking around infants puts their health at risk."

"Since more educated women not only quit more but resume less, perhaps their better understanding of the risks of maternal smoking helps them better resist the urge to resume," he said.

A grant from the National Institute for Child Health and Human Development funded the study.

Source: American Journal of Preventive Medicine 2003;24:29-35.

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Angina Alert

HealthScoutNews

Friday, January 24, 2003

(HealthScoutNews) -- Almost everyone experiences chest pain at one time or another. Sometimes, it's no cause for alarm, but often chest pain can be a warning sign of a serious problem. How can you tell the difference?

Cardiologists at the Columbia University Department of Surgery offer these guidelines in assessing chest pain:

  • If chest pain is accompanied by shortness of breath, sweating, nausea and/or dizziness, it may be a sign of angina (news - web sites) or a heart attack.
  • If it occurs with a twisting movement of the torso or with a deep breath, it is most likely not coming from the heart.
  • Classic angina starts following some kind of physical exertion, for example, after walking uphill -- particularly if the activity comes after a meal or in cold weather. Rest may relieve it.

If you experience chest pain, call a doctor for guidance. If you can't reach one, or if your pain is severe, call 911 immediately.

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Some Kids Have Medical Reason to Be Afraid of Dark

 

By Alison McCook

Reuters Health

Friday, January 24, 2003

NEW YORK (Reuters Health) - In rare instances, children who say they are afraid of the dark may not just want to postpone falling asleep. They may actually suffer from a form of night blindness, according to a new report.

UK investigators report that two young children who constantly complained of fearing the dark turned out to have a hereditary form of night blindness.

Study author Dr. Gordon N. Dutton, a consultant ophthalmologist at Gartnavel General Hospital in Glasgow, Scotland, explained that this type of night blindness, called congenital stationary night blindness, is rare. The vast majority of children who say they are afraid of the dark do not have this condition, he said.

"It's important to recognize that this is a rare thing," he told Reuters Health.

But for a small number of children, those fears of darkness and shadows are real, he added.

"So when a child (with night blindness) is frightened of the dark, they are so for a very good reason," Dutton said. "They're blind in the dark."

Children with congenital stationary night blindness are unable to adjust their sight to darkness, the researcher explained. When lights first go out, people without night blindness lose their sight for an instant, but their eyes quickly adjust to the darkness so that they can faintly pick out their surroundings.

But for children with night blindness, Dutton said, that vision adjustment never occurs, rendering them "totally blind in the darkness."

In the January 25th issue of the British Medical Journal, Dutton and his colleagues describe the cases of two young girls who were diagnosed with congenital stationary night blindness.

One 3-year-old girl said she could not see when the lights were turned out, and would refuse to go into her parents' room when it was dark. When her younger sister was diagnosed with vision problems, the parents brought their older daughter to have her eyes examined, and doctors recognized her condition.

The other case involved a 2-year-old girl who had trouble navigating dark rooms. When she woke up in the dark, she felt afraid and would cry. An eye exam revealed that she had congenital stationary night blindness.

In an interview, Dutton noted that this form of night blindness is inherited, and in many instances, kids are diagnosed early with the condition because their eyes "wobble" in their sockets. However, in rare cases, such as the two described in the current study, none of these warning signs appear.

The condition is called stationary because it does not get worse over time. Dutton recommended that parents with children diagnosed with night blindness pull curtains closed before turning out lights, so that children do not become afraid of the black void they see through the windows.

Both children featured in the current report improved after they were given control of their room lighting, which allowed them to see when they wanted to.

Source: British Medical Journal 2003;326:211-212.

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More Pain, More Gain

HealthScoutNews

Friday, January 24, 2003

(HealthScoutNews) -- The latest buzz is that short-intensity exercise burns as much if not more calories as a longer, lower-intensity workout.

According to the Mayo Clinic, a 154-pound person will burn:

  • 319 calories running 8 miles per hour for 20 minutes
  • 238 calories walking 3 mph for 60 minutes

But high-intensity exercise also increases the risk of injury. Also, many people find it tough to sustain.

So if an intense workout is not for you, follow the advice of fitness experts. They recommend 30 minutes or more a day of moderate-intensity exercise, such as walking, biking or gardening.

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Many Austrians May Have High Homocysteine

 

By Jane Burgermeister

Reuters Health

Friday, January 24, 2003

VIENNA (Reuters Health) - As many as one in three Austrians may have high levels of homocysteine, an amino acid suspected of increasing the risk of heart disease, doctors said on Friday.

This figure, which came from a relatively small study, is much higher than the previous estimate that one in ten Austrians have raised levels of the molecule.

"We were not surprised to find that many people had high levels of homocysteine because half of all the deaths in Austria are due to heart and circulatory disease and homocysteine has been associated with these diseases," the head of the study, Dr. Bernhard Zirm, told Reuters Health.

"However, we were shocked to find it was as many as one in three," added Zirm, who is at Bad Radkersburg Hospital in southern Austria.

The results of the study support the importance of a healthy lifestyle and a diet that is rich in folic acid, Zirm said. Participants who consumed the least folic acid and vitamins B6 and B12 had the highest homocysteine levels.

In the study, which has not yet been published, the team analyzed data from 528 people between 20 and 75 years old who were living in the Bad Radkersburg area. Overall 31% of the study group had elevated homocysteine levels.

The study also found a clear link between age and homocysteine levels. Older participants tended to have higher levels of the amino acid.

"While only 11% of the subjects between 20 and 40 years had high levels of homocysteine, as many as 56% of those who were between 60 and 75 had high levels," Zirm said.

Zirm says that the second phase of his study, in which patients at a high risk of developing heart and circulatory diseases will be treated with folic acid and vitamin B supplements, should be completed in the autumn.

High levels of homocysteine have been under suspicion as a risk factor for heart disease and stroke. However, the benefits of lowering homocysteine levels have not been demonstrated, so homocysteine, unlike cholesterol, is not routinely measured.

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New Help for Enlarged Prostates

HealthScoutNews

Friday, January 24, 2003

FRIDAY, Jan. 24 (HealthScoutNews) -- The drug Avodart, used to treat symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate, is now available by prescription in the United States.

Avodart is a 5 alpha-reductase inhibitor that arrests the BPH disease process. The current most commonly prescribed treatment for BPH, alpha blockers, treat only the symptoms of BPH.

BPH is among the most common health problems in older men. More than half of men over age 60 experience BPH. It's a progressive disease in which the prostate gland surrounding the urethra enlarges. As it becomes larger, the prostate obstructs the urethra and causes urinary problems.

BPH symptoms include a hesitant, interrupted weak urine stream, urinary urgency and leaking or dribbling, and more frequent urination, especially at night. In severe cases of BPH, the bladder and kidney may be damaged.

BPH often begins after age 50. It can progress and worsen as men grow older. Men with at least a 10-year life expectancy should have a annual prostate checkup beginning at age 50, says the American Urological Association.

More information

Here's where you can learn more about prostate problems.

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Parkinson's Drug Linked to Heart Disease

 

By Alison McCook

Reuters Health

Friday, January 24, 2003

NEW YORK (Reuters Health) - People with Parkinson's disease (news - web sites) who take the drug levodopa to control their symptoms appear to have a higher than average risk of heart disease, US researchers report.

It is not clear whether levodopa itself raises heart disease risks, but previous research has shown that the drug can boost body levels of homocysteine, an amino acid associated with an increased risk of stroke and heart disease.

These preliminary findings "raise certain concerns" about the safety of levodopa, but are not meant to discourage people from taking the drug, study author Dr. Ramon Diaz-Arrastia told Reuters Health.

"I think if patients need levodopa because of (Parkinson's) symptoms, then they should be on it. It's certainly the most effective therapy," he noted.

Parkinson's disease is a progressive neurological disorder marked by the loss of brain cells that produce dopamine, a chemical key in controlling muscle activity. When dopamine levels are low, normally coordinated brain regions that control body movement become out of sync, leading to tremors, muscle rigidity, slowed movement and balance and coordination problems.

Levodopa is a precursor to dopamine in the brain, and the synthetic version can greatly alleviate patients' symptoms. It does not cure the disorder, though.

During the current study, Diaz-Arrastia, of the University of Texas Southwestern Medical Center in Dallas, and his colleagues measured homocysteine levels in blood samples from 235 people with Parkinson's, including 201 who had received levodopa. Diaz-Arrastia and his team also asked participants if they had ever had a heart attack or had undergone open-heart surgery or the artery-clearing procedure angioplasty.

People who said they had received levodopa tended to have higher levels of homocysteine in their blood than people who had never taken the drug. People with the highest levels of homocysteine in their blood were more likely to have developed heart disease.

The results of the study do not prove that levodopa causes the increases in homocysteine levels and heart disease risk, according to Diaz-Arrastia.

That said, he noted that previous studies have suggested that high levels of homocysteine can boost the risk of dementia, and approximately one third of patients with Parkinson's disease eventually develop dementia. So the question arises whether levodopa could either worsen Parkinson's or increase the risk that people with the disease will develop dementia.

"That is obviously one of the potential implications of this work," Diaz-Arrastia said.

Low levels of vitamin B12 and folic acid, or folate, are most often to blame for increases in homocysteine in the blood, the researcher added. Deficiencies in these B vitamins did not explain the differences in homocysteine levels among Parkinson's patients in the study.

Still, Diaz-Arrastia suggested that patients with Parkinson's who discover they have high homocysteine levels take a multivitamin rather than stop therapy with levodopa, if the drug appears to be helping.

Source: Archives of Neurology 2003;60:59-64.

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Having a Baby to Please a Guy

HealthScoutNews

Friday, January 24, 2003

THURSDAY, Jan. 23 (HealthScoutNews) -- Poor, black teenage girls who believe their boyfriends want a baby are 12 times more likely to wish they were pregnant than similar girls who don't feel that pressure from their boyfriends.

A study in the January issue of the American Journal of Health Behavior came to that conclusion after interviewing more than 400 sexually active black teenage girls in Alabama.

The researchers also found the girls in the study who said they wanted to become pregnant were nearly four times more likely to have a male partner who was at least five years older. Girls who wanted to get pregnant were twice as likely to report low self-esteem and low family support.

The study found those girls were also twice as likely to feel their partner would not approve of using condoms when they had sex.

All these factors could be altered by behavioral intervention, meaning they could be important points to consider when creating programs to reduce pregnancy risk in black teenage girls, the researchers say.

The study included interviews and surveys of 462 girls, aged 14 to 18, living in low-income neighborhoods in Birmingham, Ala.

Forty percent of the girls in the study had a previous pregnancy. However, the girls who said they wanted to become pregnant were less likely to report they had a previous pregnancy.

More information

Here's where you can learn more about teenage pregnancy.

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Liver Enzyme Implicated in Artery Disease

 

Reuters Health

Friday, January 24, 2003

NEW YORK (Reuters Health) - An enzyme found in the liver and intestines may play a key role in clogging of the arteries that can cause heart disease, research in mice suggests.

Just how important the enzyme is in human disease is not yet clear. But researchers say studies should now look into whether blocking the enzyme with a drug could prevent or treat atherosclerosis in humans.

Atherosclerosis involves hardening and narrowing in the arteries. The condition is a major cause of heart attack and stroke.

The new study links the disease to a cholesterol-modifying enzyme called ACAT2, which exists primarily in the liver and small intestine. ACAT2 helps change the cholesterol naturally made in cells so that it can travel in the blood. And high levels of blood cholesterol contribute to atherosclerosis.

Researchers found that in a strain of lab mice susceptible to atherosclerosis, those genetically altered to lack the ACAT2 enzyme did not develop significant signs of the disease in contrast to those with the enzyme.

In addition, the enzyme-deficient mice had lower total cholesterol levels but higher concentrations of heart-healthy HDL cholesterol.

All of this suggests that ACAT2 activity is "crucial for the development of atherosclerosis in mice," the study authors report in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites).

And while mouse and human atherosclerosis do differ, they add, it's possible that blocking ACAT2 in the liver and intestines could help prevent or treat atherosclerosis.

Dr. Robert V. Farese Jr., of the University of California at San Francisco, and colleagues conducted the study.

Scientists have already tried their hand at ACAT-blocking drugs, Farese and his colleagues note, but these agents were created before researchers discovered that there are actually two forms of the enzyme--1 and 2.

ACAT1, unlike its cousin, exists in many tissues throughout the body, and one study in mice has shown that blocking it could actually promote atherosclerosis.

The new findings, according to Farese's team, suggest that drugs that selectively target ACAT2 should be studied in humans.

Source: Proceedings of the National Academy of Sciences 2003.

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New Guidelines Place More at Thyroid Risk

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, January 24, 2003

THURSDAY, Jan. 23 (HealthScoutNews) -- When it comes to thyroid function, what was normal yesterday may not be normal today.

The American Association of Clinical Endocrinologists (news - web sites) (AACE) has announced new guidelines that will probably double the number of people with thyroid disease.

"This means that there are more people with minor thyroid abnormalities than previously perceived," AACE president Dr. Hossein Gharib said this week at a press conference. He added that earlier treatment means a lower likelihood of complications -- including depression and heart disease -- later on.

With the new guidelines, Gharib said, the prevalence of thyroid disease will be about equal to diabetes and cancer combined, affecting 27 million people, up from 13 million under the old guidelines. This would make thyroid disease the most common endocrine disorder in North America.

The announcement was made as the AACE kicked off its annual thyroid awareness month with the 2003 campaign theme: "Hiding in Plain Sight: Thyroid Undercover."

The thyroid is a small, butterfly-shaped gland in the front of the neck that produces thyroid hormone. "The hormone reaches cells through the bloodstream and affects just about every tissue in the body," Gharib said. "If your thyroid doesn't work properly, neither do you."

Basically, two things can go wrong with the thyroid. The gland can become overactive, producing too much hormone (hyperthyroidism), or it can become underactive, producing too little hormone (hypothyroidism).

Although the early symptoms of thyroid disease are often subtle (including fatigue, intolerance to cold and weight changes), long-term complications can range from depression and other psychiatric conditions to bone loss and even coma or death.

"It's important to diagnose this early before problems arise," said Dr. Donald Bergman, an endocrinologist and president-elect of AACE. "The good news is that a readily available, inexpensive blood test, which all physicians can do, provides evidence of early thyroid disease before complications develop."

Physicians use a simple blood test, the thyroid stimulating hormone (TSH) test, to determine if the thyroid is working properly. Previously, normal was between 0.5 and 5.0 micro units per milliliter of blood. The new guidelines, however, stipulate normal to be within a much narrower range: between 0.3 and 3.0.

The impetus for this change came from studies showing that even subclinical (without overt symptoms) hyperthyroidism can be shown to affect the health of untreated patients years down the line.

"If left untreated, thyroid disease can lead to significant problems," Gharib said. "We don't want to overlook signs of early disease."

Hypothyroidism is easily treated with replacement hormone. Overactive thyroid can be treated a number of different ways, including drugs and radioactive iodine.

Standards for healthy cholesterol and blood glucose levels have also been changing, said Dr. Loren Wissner Greene, clinical associate professor of medicine at New York University School of Medicine and a member of the national medical advisory board for the Thyroid Foundation of America.

"We keep on having changes in our normal values," she said. "Generally, the idea is that it is going to help more people by diagnosing them sooner. Our standards are to catch people more readily. It's still going to be a doctor's decision whether or not to treat someone."

The TSH test has also become much more accurate, Greene added. "We can now respond much more appropriately."

Because the incidence of thyroid disease increases as we age, the AACE recommends that women over the age of 35 and men over 60 be screened annually. (Women are up to eight times more likely than men to be diagnosed with thyroid disease, according to the AACE.) In addition, anyone with a family history, anyone with an autoimmune disorder such as anemia, arthritis or certain forms of diabetes, and women who are thinking about getting pregnant should be tested.

"If the TSH falls out of the normal range -- now 0.3 to 3.0 -- then you should seek advice from your physician," Bergman said. Not every single one of these people will be treated, either, he adds: "Each person should be considered on individual basis."

More information

For more on thyroid disease, visit the American Association of Clinical Endocrinologists, which also has a page on how to conduct a "neck check" at home.

The American Thyroid Association also has a wealth of information

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Exercise Like a Drug in Heart Disease, Study Finds

 

Reuters

Friday, January 24, 2003

WASHINGTON (Reuters) - Exercise can act like a drug on the blood vessels, reducing the risk of heart disease by literally getting the blood flowing, US researchers said on Thursday.

It works in a surprising way, reducing inflammation, which has recently joined high blood pressure and high cholesterol as a leading known cause of heart disease, the researchers said.

The blood stresses the walls of blood vessels as it passes over them, reducing inflammation in a way similar to high doses of steroids, the researchers report in Friday's issue of Circulation Research.

"Inflammation in blood vessels has been linked to atherosclerosis, a hardening of the arteries, and here we see how the physical force of blood flow can cause cells to produce their own anti-inflammatory response," Scott Diamond of the University of Pennsylvania's Institute for Medicine and Engineering, said in a statement.

"Conceivably, exercise provides the localized benefits of glucocorticoid--just as potent as high doses of steroids, yet without all the systemic side effects of taking the drugs themselves," added Diamond, who led the study.

"Perhaps this is a natural way in which exercise helps protect the vessels, by stimulating an anti-inflammatory program when the vessels are exposed to elevated blood flow."

The findings could help explain why exercise works so well to reduce the risk of heart disease, Diamond said.

"We're not talking about running a marathon here. We're just talking about getting the blood moving at high arterial levels," he said.

Studies in recent years have found that cells and chemicals linked with inflammation can be found in arterial clogs, and much research is now focusing on ways to reduce this inflammation. For instance, teams are investigating whether giving patients antibiotics or anti-inflammatory drugs lowers their risk of heart disease.

Diamond has worked using human arteries in the lab but wants to move into animals to confirm his hypothesis.

"Think of blood flow as a stream--whenever a stream branches off you get small areas of recirculation eddies or pools of stagnant water," he said.

"These same situations of disturbed flow irritate the endothelium (the lining of the blood vessels). When blood vessels branch off, all the arterial flotsam--fats and activated blood cells--can clump and stick at these hot spots for atherosclerotic plaque formation," he added.

"Perhaps, elevated blood flow may alter these disease-prone regions to relieve some of the localized inflammation."

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Rock-a-bye Baby, Sleep Through the Night

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, January 24, 2003

FRIDAY, Jan. 24 (HealthScoutNews) -- Want to know how to get your infant to sleep through the night?

Don't be so quick to feed your baby when he or she cries out, a new study says.

Researchers had nearly 600 mothers in England keep a diary about their infants' sleeping and eating patterns during the first 12 weeks of life.

The researchers found that babies who were fed more than 11 times during a 24-hour period were three times as likely as babies who were fed fewer times to wake repeatedly during the night.

"It's possible to predict babies who will be sleeping through the night at 12 weeks of age by measuring how many feeds they have at one week of age," says Ian St. James-Roberts, lead author of the study and a professor of child psychology at the University of London.

The next step was figuring out how to break the pattern.

The researchers identified 134 babies who were fed more than 11 times in a 24-hour period and therefore "at risk" of driving their parents to exhaustion by waking up at night.

Those babies were divided into two groups. One group was put on a behavioral program; the other wasn't.

The behavioral program taught parents to begin teaching their child from birth that day and night are different. Parents were instructed to do things such as keeping their baby active and playing during the day, making sure the sleeping area was dark and quiet, and not letting them fall asleep wherever they happened to be or while feeding.

After three weeks of age, as long as the child was gaining weight satisfactorily, mothers were taught to delay or avoid feeding the infant when he or she woke up at night.

Instead, the mothers would change the diaper or do some other activity to break the association with waking up at night and getting fed, St. James-Roberts says.

Eighty-two percent of the babies on the behavioral program slept through the night at 12 weeks, compared with 61 percent of babies not on the program, the study found.

Whether the babies were breast-fed or bottle-fed made little difference, the researchers note.

Their study appears in the Jan. 22 issue of the Archives of Disease in Childhood.

Dr. George Cohen, a pediatrician and editor-in-chief of the American Academy of Pediatrics' "Guide to Your Child's Sleep," says encouraging mothers to delay feeding their baby at night to promote sleep is "perfectly reasonable."

"If you can settle him down without a feeding, with just soothing murmuring, rubbing his tummy or patting his head to calm him down, the academy goes along with that," Cohen says. "If it works, good for you."

But the fact is, it's unreasonable to expect a baby who's just a few weeks old to sleep more than five or six hours at a stretch, he says. And sometimes, the baby will demand nothing less than being fed.

"You may just have to live with [being woken up at night] for awhile," Cohen says. "Sometimes feeding a baby is the only thing that works."

About two-thirds of babies in industrialized nations sleep through the night by the time they're 12 weeks old, according to the study.

Parents commonly take babies who don't sleep through the night by this age to the pediatrician for advice.

Among cultures, there's a wide range of beliefs about how often an infant should be fed, ranging from regular, four-hour intervals to on demand, St. James-Roberts says.

"We're not talking about normal or abnormal," St. James-Roberts says. "The issue is what do you want? If your purpose is to have your baby sleep through the night at 12 weeks of age, then this study gives you some information to help you achieve that purpose."

St. James-Roberts stresses his study doesn't mean to imply that mothers who feed their baby 11 times or more are overfeeding them. However, feeding the child fewer times during a 24-hour period will improve their sleep habits, he says.

"There has been some misunderstanding that we are talking about babies being overfed or not feeding babies when they're infants," he says. "It's not about any of those things. It's simply about the number of feeds."

The American Academy of Pediatrics' guidelines for breast-feeding say feeding, especially breast-feeding, an infant eight to 12 times a day is perfectly normal. They also recommend feeding an infant on demand.

However, Cohen says new parents sometimes have a hard time figuring out what "on demand" means.

"When the baby is crying, are you sure you know what the baby's demanding?" Cohen says. "When a baby cries, the first thing some parents do is stick a bottle or a breast or a pacifier in their mouth, which may teach the baby that crying is the only way to get that."

More information

To read the American Academy of Pediatrics' guidelines for breast-feeding, click here. LaLeche League also has information about feeding infants.

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Drug Shown to Prevent Breast Cancer in Some Women

 

Reuters

Friday, January 24, 2003

LONDON (Reuters) - The most widely prescribed drug for treating breast cancer (news - web sites) can also prevent the disease in healthy high-risk women, doctors said on Friday.

A review of the results of several breast cancer prevention trials showed that the drug, tamoxifen, reduced new cases of the illness by 38%.

"In our analysis we combined all the available evidence from studies using tamoxifen for breast cancer prevention collectively involving over 40,000 women," Dr. Jack Cuzick, of the charity Cancer Research UK, said in a statement. "It is clear to us now that the drug can reduce the chance of high-risk women developing the disease."

The drug, launched in 1973, also reduced new cancers in the opposite breast by 46% in women with tumors sensitive to the female hormone estrogen who had already been treated for the disease.

Tamoxifen neutralizes the action of estrogen, which stimulates breast cancer growth. The drug is ineffective against tumors that are not sensitive to the hormone.

But Cuzick and his colleagues, whose findings are published in the medical journal The Lancet, said more research was needed to reduce the side effects of the medication before it can be prescribed as a preventative drug. Tamoxifen is linked to an increased risk of blood clots and cancer of the lining of the womb.

"It may be possible to reduce the side effects of tamoxifen by using a lower dose or adding low-dose aspirin," Cuzick said. "Carefully selecting women to exclude those already at risk of blood clotting disorders or endometrial cancer may also be a way of making the use of tamoxifen more viable."

In a cancer prevention trial of 7,700 high-risk women, another drug called raloxifene reduced new cases of breast cancer by 64% compared to a placebo, or dummy drug.

Raloxifene is made by Eli Lilly and Company under the name Evista.

"The early data on raloxifene looks very promising," according to Cuzick. "The trial shows that the drug can reduce the risk of breast cancer by 64% and cause fewer side effects than tamoxifen," he added.

Cuzick said doctors are eagerly awaiting the results of an American trial that directly compares the two drugs.

Tamoxifen's role in preventing cancer has been controversial. Several years ago, researchers reported that it reduced breast cancer cases by 45% in a US trial that was cut short to allow women on the placebo to take tamoxifen instead.

At the time, British researchers criticized the US decision, saying long-term studies were needed to confirm the drug's effectiveness as a cancer preventative.

"The evidence to date clearly shows that tamoxifen can reduce the risk of breast cancers stimulated by the hormone estrogen. However, it is crucial that we follow all the trials to their conclusions and find ways to reduce the side effects of tamoxifen before we can recommend that high-risk women take the drug to prevent breast cancer," Cuzick said.

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Wasting Away

HealthScoutNews

Friday, January 24, 2003

FRIDAY, Jan. 24 (HealthScoutNews) -- A gene that regulates muscle formation in fruit flies may play an important role in a severe human wasting disorder called cachexia, which is commonly associated with cancer, AIDS (news - web sites) and chronic infection.

The study by University of Texas Southwestern Medical Center at Dallas researchers appears in the Jan. 23 issue of Cell.

The gene, known as a twist, encodes a gene-regulatory protein that controls muscle formation in fruit flies. The researchers wanted to compare the function of that gene in mammals. Working with mice, they found it had a different function than in fruit flies.

Mice that were genetically engineered to lack the twist gene were underweight, frail and developed cachexia.

This finding about the twist gene's role in mammals may provide important information that could help in the development of better drugs to treat cachexia and other conditions in humans.

More information

Here's where you can learn more about cachexia.

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Doctors Warn of Possible New Risk for IVF Babies

 

Reuters

Friday, January 24, 2003

LONDON (Reuters) - Test tube babies could have a possible increased risk of developing a rare form of eye cancer, Dutch scientists warned on Friday.

Although there is no confirmed evidence linking in-vitro fertilization (IVF) with cancer, researchers at the VU University Medical Center in Amsterdam said IVF babies could be between five and seven times more likely to develop retinoblastoma than other children.

But the European Society of Human Reproduction and Embryology (ESHRE), which represents 4,000 fertility experts worldwide, said the research should be treated with caution.

Dr. Annette Moll and her team compared the incidence of the eye cancer in IVF children and those conceived naturally after diagnosing the illness in five test tube babies within 15 months.

Retinoblastoma normally occurs in about one in every 17,000 births in the Netherlands and other western countries.

"Our finding requires further research to confirm the association and to explore a possible causal mechanism," Moll said in a report in The Lancet medical journal.

All of the cancers were in children born between 1997 and 2001 and the youngsters were treated successfully.

Moll said it could be just chance but because no cases of the illness had been found in test tube babies born from 1980-1995, it represented a "striking excess" in the frequency of the illness.

The British Fertility Society said the chance of any child, conceived naturally or through IVF, of developing cancer before the age of 15 is one in 600.

"We do not have any evidence that the overall risk of cancer is increased after assisted conception treatment," the society said.

Professor Christina Bergh, from Sahlgrenska University Hospital in Gteburg, Sweden and a member of ESHRE, said fertility experts agree that children born through assisted reproduction techniques should be followed right through their childhood.

"But the present report should be treated cautiously for now," she said.

The Human Fertilization and Embryology Authority (HFEA), which licenses fertility clinics in Britain, and the government's Medical Research Council (MRC) announced in October that they will asses any potential health risks resulting from assisted reproduction techniques.

A spokeswoman for the HFEA stressed that there was no reason for parents of babies born through IVF to be concerned.

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THURSDAY, JANUARY 23, 2003

Lead Removal Improves Kidney Function

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Thursday, January 23, 2003

THURSDAY, Jan. 23 (HealthScoutNews) -- Exposure to moderate lead levels may worsen chronic kidney disease, but lead-removal treatment can slow the disease's progression and improve kidney function, claims new research.

The study, published in the Jan. 23 issue of The New England Journal of Medicine (news - web sites), focused on 64 patients with chronic renal insufficiency and elevated lead levels in the high end of the normal range. None of the patients had diabetes, the leading cause of kidney failure in the United States.

Of the 64 patients, 32 received chelation therapy -- injections of EDTA (ethylene diamine tetra-acetic acid), a synthetic amino acid, over a 27-month period. The EDTA binds to the molecules of lead in the blood, and the two are expelled from the body in the urine.

Those who received EDTA treatments had "significantly" improved kidney function and reduced lead levels at the end of the treatment period, according to the researchers.

For 32 patients in a control group, who received placebos during the same period, lead levels increased and kidney function continued to deteriorate.

"So if we look at the body lead [levels], we may provide another way to slow the progression of renal disease," says researcher Dr. Kun-Ying Pan, a kidney specialist at Chang Gung Memorial Hospital in Taipei, Taiwan. "And that means a lot because it can reduce the time someone needs to be on dialysis treatment."

The study, he says, demonstrated a direct relationship between elevated lead levels and chronic kidney disease. Anyone suffering from progressively worsening kidney disease of unknown cause should have body lead levels checked, he adds.

Dr. Philip Marsden, a professor of medicine at the University of Toronto and St. Michael's Hospital, says the study shows that those with chronic kidney disease are particularly susceptible to lead exposure. The research also should be a beacon of hope for those with kidney disease and elevated lead levels, adds Marsden, who wrote an editorial accompanying the study.

"Their kidney function was remarkably improved if they got the chelation therapy," Marsden says. "Now we need to be more cognizant of it because if you give them something to treat the high lead levels, it makes them better. It's not academic; it's a practical matter that can save their kidneys."

Dr. David G. Warnock, director of the division of nephrology at the University of Alabama, Birmingham, and president-elect of the National Kidney Foundation, says the findings should lead to more lead screening of patients with chronic kidney disease when the primary cause remains undetermined.

Among those who treat kidney disease, he says, "lead exposure is not necessarily on the first page, and this paper would suggest that since we're always looking for treatable cases of chronic kidney disease, we should bring this forward in terms of the attention."

The Taiwan study went so far as to assert that chelation therapy could improve kidney function enough to delay the need for dialysis by about three years. And, the study says, the tab for chelation therapy would amount to a fraction of the cost of dialysis.

Precisely how or why lead-chelation therapy improves kidney function remains unknown, the researchers acknowledge. But they suggest elevated lead levels may increase reactive oxygen species, highly reactive chemicals that attack other molecules and modify their chemical structure, and that chelation could reduce the level of these chemicals.

Marsden agrees it's unclear why chelation improved kidney function and says the study failed to prove reducing lead levels alone improved kidney function. He says effects of the chelation other than lead reduction could have improved kidney function. For example, he explains, EDTA binds to other compounds, including iron, and inhibits enzymes.

Further research -- with more subjects, including U.S. patients -- could help determine whether significant differences exist between lead exposure levels in Taiwan and North America, Marsden says.

Nearly 8 million Americans, or 4 percent of U.S. adults, have lost more than half of their kidney function, the Johns Hopkins Bloomberg School of Public Health estimates. Another 6 percent, or 11 million adults, have the persistent presence of protein in their urine, one of the first signs that kidney disease is developing.

More information

Learn about kidney disease from the National Kidney Foundation or the American Association of Kidney Patients.

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Our Brain Sees Screen Flickers, Even if We Don't

 

By Alison McCook

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - Television and computer screens update images many times a second. While we may not be conscious of this "screen flicker," new research suggests that certain regions of our brains register these tiny image alterations.

The fact that we see the image as steady, and not oscillating, suggests that the brain regions that acknowledge screen flicker do not send that information to the rest of the brain.

"We hypothesize that the brain operates as a kind of filter for this excess of useless visual information," Drs. Pierre Krolak-Salmon and Marie-Anne Henaff of the Institut National de la Sante et de la Recherche Medicale Unite in Lyon, France, told Reuters Health in an E-mail interview.

The researchers noted that these findings offer a reason why some people with epilepsy have seizures while watching television or playing video games.

"For this particular population of patients, computer screen flicker may represent a danger," they said. "Our findings emphasize that the brain processes this kind of very rapid unperceived stimulus, which may represent an overload for the nervous system."

And even people without epilepsy may experience problems as a result of screen flicker, Krolak-Salmon and Henaff continued.

"Computer screen flicker, when its frequency is low, may induce headache, eyestrain and glare," they explained, especially in people who are prone to headaches.

Previous research has suggested that people have less discomfort with higher frequencies--such as 100Hz--but most televisions in France flicker at around 50Hz, and computer screens at 60Hz to 85Hz, the authors explained.

But the authors cautioned that people should not feel that their screens pose serious health risks. "We do not think that people watching a computer screen all day long have a real health risk," they said. "However, photosensitive epileptic patients and people subject to migraines must be careful."

Experts have shown that seizures can be triggered by lights flashing or flickering at certain frequencies, or the geometric patterns in the video display of computer games. This condition, known as photosensitive epilepsy, is more common in children and adolescents and becomes less frequent with age.

The current study findings, reported in the January issue of Annals of Neurology, are based on results from three patients with epilepsy that did not respond to drugs and were considering surgery to remove the portion of their brain inducing seizures.

Before surgery, doctors implanted electrodes in their brains to home in on the specific area originating the seizures, and monitored the activity in these brain regions for two weeks.

The authors found that patients showed increased brain activity when exposed to screen flicker in regions of the brain involved in processing visual information, indicating that portions of their brains were "seeing" screen flicker.

People can sidestep side effects of screen flicker by watching plasma screens, which have no flicker, Krolak-Salmon and Henaff said.

Krolak-Salmon also holds a position at the Hopital Neurologique, also in Lyon.

Source: Annals of Neurology 2003;53:73-80.

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Study Backs Common Therapy for Preeclampsia

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Thursday, January 23, 2003

THURSDAY, Jan. 23 (HealthScoutNews) -- For women with preeclampsia, a dangerous complication of pregnancy, the drug magnesium sulfate works better than a drug designed to dilate blood vessels in the brain, researchers say after comparing the two.

The finding is also leading researchers to rethink what causes preeclampsia in the first place.

While magnesium sulfate is the accepted treatment for preeclampsia, Dr. Michael A. Belfort and his colleagues decided to compare it with nimodipine (brand name Nimotop), a drug used to open brain blood vessels, because they thought it might work better and be more convenient.

Constricted blood vessels in the brain are thought to lead to the condition. Magnesium sulfate is usually administered intravenously, while nimodipine can be given orally when a woman has preeclampsia, a condition marked by high blood pressure, sudden weight gain and protein in the urine. Left untreated, preeclampsia can progress to eclampsia, marked by seizures, agitation and unconsciousness.

"The hypothesis that we set out to test was that nimodipine would prevent more seizures than magnesium sulfate," says Belfort, a professor of obstetrics and gynecology at the University of Utah and lead author of the study. It appears in the Jan. 23 issue of The New England Journal of Medicine (news - web sites).

However, magnesium sulfate was better at preventing seizures, the team reports. Even more important than that finding, Belfort says, is that the result calls into question whether preeclampsia is really caused, as experts have believed, by the brain's blood vessels constricting and going into spasm.

"From my perspective, the study's most significant contribution is that it sheds light on the pathophysiology of eclampsia," Belfort says. If it is truly caused by constricted circulation in the brain, the drug to open brain blood vessels should have worked better than the magnesium sulfate.

Based on the study results, "we are now able to say with reasonable certainty that the most common form of eclampsia is probably not caused by vasospasm or ischemia [reduced blood flow] and is much more likely to be the result of overperfusion [too much blood] than underperfusion," Belfort says./p>

In the study, Belfort's team randomly assigned 1,650 women with severe preeclampsia to receive either 60 milligrams of nimodipine every four hours or intravenous magnesium sulfate, continuing until a day after giving birth. While 2.6 percent of the nimodipine-treated women had seizures, only 0.8 percent of those on magnesium sulfate did.

The study was funded in part by Bayer Corp., which makes Nimotop.

Worldwide, preeclampsia and eclampsia occur in about 3 percent of pregnant women and are blamed for 12 percent of pregnancy-related deaths, according to the World Health Organization (news - web sites). About 2 percent of women with preeclampsia develop eclampsia.

Last year, a study published in The Lancet involving more than 10,000 pregnant women from 33 countries found that women with preeclampsia who received magnesium sulfate had a 58 percent lower risk of eclampsia than those who received inactive placebo. Magnesium sulfate was so superior to placebo that the study was halted early.

Another expert, Dr. Baha Sibai, agrees the contribution of the most recent study is the doubt it sheds on the traditional view of how and why eclampsia develops.

"What this study shows is that magnesium sulfate is better than nimodipine at preventing seizures, so it is unlikely it works by relaxing the blood vessels in the brain," says Sibai, chairman of the department of obstetrics and gynecology at the University of Cincinnati.

"Exactly how magnesium sulfate works [to prevent the seizures of eclampsia] is not known," he says. "But we still believe it's the best drug."

More information

For more information on preeclampsia and eclampsia, try the National Library of Medicine or the Preeclampsia Foundation.

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Study Says Broken Homes Harm Kids More 

By Emma Ross

AP Medical Writer

The Associated Press

Thursday, January 23, 2003

LONDON - Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study.

Researchers have for years debated whether children from broken homes bounce back or whether they are more likely than kids whose parents stay together to develop serious emotional problems.

Experts say the latest study, published this week in The Lancet medical journal, is important mainly because of its unprecedented scale and follow-up it tracked about 1 million children for a decade, into their mid-20s.

The question of why and how those children end up with such problems remains unanswered. The study suggests that financial hardship may play a role, but other experts say the research also supports the view that quality of parenting could be a factor.

The study used the Swedish national registries, which cover almost the entire population and contain extensive socio-economic and health information. Children were considered to be living in a single-parent household if they were living with the same single adult in both the 1985 and 1990 housing census. That could have been the result of divorce, separation, death of a parent, out of wedlock birth, guardianship or other reasons.

About 60,000 were living with their mother and about 5,500 with their father. There were 921,257 living with both parents. The children were aged between 6 and 18 at the start of the study, with half already in their teens.

The scientists found that children with single parents were twice as likely as the others to develop a psychiatric illness such as severe depression or schizophrenia, to kill themselves or attempt suicide, and to develop an alcohol-related disease.

Girls were three times more likely to become drug addicts if they lived with a sole parent, and boys were four times more likely.

The researchers concluded that financial hardship, which they defined as renting rather than owning a home and as being on welfare, made a big difference.

However, other experts questioned the financial influence, saying Swedish single mothers are not poor when compared with those in other countries, and suggested that quality of parenting could also be a factor.

"It makes you think that what you're seeing is just the most dysfunctional families having these problems, rather than the low income. The money is really an indicator of something else," said Sara McLanahan, a professor of sociology and public affairs at Princeton University, who was not involved in the study.

"If you really thought that it was the income that makes the difference, you would think that Swedish lone mothers would do a lot better than the British or those in the U.S., but they look very similar," she said.

Other experts agreed.

In the last 20 to 30 years, poverty has been greatly reduced everywhere in Europe, but psychiatric problems in children have not, said Dr. Stephen Scott, a child health and behavior researcher at the Institute of Psychiatry in London, who also was not involved in the study.

He said that in previous studies, once researchers have adjusted their results to eliminate the influence of bad parenting, any increased risk of emotional problems shrinks markedly. This, he said, indicates it is not so much single parenthood but the quality of parenting that is at issue.

"The kind of people who end up as single parents might not have done well by their kids, even if they hadn't ended up alone. They tend to be more critical in their relationships, more derogatory toward other people," Scott said, adding that it is also harder to be a warm, non-critical parent when you're bringing up a child alone.

However, he noted that there are plenty of children from single-parent families who don't end up with serious emotional problems.

There may also be a genetic element: More irritable people are more likely to become separated, but they are also more likely, whether they are separated or not, to have more irritable children, Scott said.

"The whole field is highly debated. This is another piece in that debate that makes several important points firstly that there really is an increased risk in young adulthood of pretty bad things. It also indicates it's not all about the money, but may be about the people themselves," McLanahan said.

On the Net:

The Lancet, http://www.thelancet.com

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Brain to Blame When You Can't Match Face with Name

 

By Amy Norton

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - People who have trouble putting a name to a familiar face may now know which part of their brain to blame.

Scientists reported Thursday that they have discovered the brain regions integral in learning, and later recalling, the name of that new acquaintance.

Using sensitive brain-imaging techniques, they were able to "unfold" the spiraling brain structure responsible for learning new memories--called the hippocampus--and identify the subdivisions that jump into action during face/name association.

"The major center for learning new memories is actually divided into smaller sub-regions, each of which appears to play a different role during learning," study author Susan Y. Bookheimer told Reuters Health.

Bookheimer and her colleagues at the University of California Los Angeles used a technique called functional MRI to record the brain activity of volunteers as they learned, and later tried to recall, the names that went with new faces. They then used a technique that unfurls the imaged hippocampus into a "flat map," allowing them to study activity in the structure's subdivisions.

From there, they discovered that certain sub-regions appear vital in learning a new association (a certain name goes with a certain face), while a different area is especially important in "retrieving" the new memory ("I know that face...what's his name?").

The findings, published in the January 24th issue of Science, could also aid in understanding the nature of memory impairment in disorders such as Alzheimer's disease (news - web sites), according to Bookheimer.

The hope, she explained, is to use advanced imaging techniques to spot early brain changes that accompany diseases like Alzheimer's.

"If we can understand how each of these (hippocampus) sub-regions is supposed to operate," Bookheimer said, "we may be able to detect subtle breakdowns in a stage early enough to benefit patients with new treatments and interventions."

Source: Science 2003;299:577-580.

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New Patient Gets Artificial Heart in Ky.

The Associated Press

Thursday, January 23, 2003

LOUISVILLE, Ky. - Surgeons have implanted a self-contained artificial heart in another critically ill patient, barely two weeks after such operations resumed following a long hiatus.

The 10-hour operation was performed on Wednesday, bringing to three the number of people now living with AbioCor artificial hearts.

Jewish Hospital said in a statement that the patient and another recipient, who received the softball-size device at the hospital on Jan. 7 were both in critical but stable condition. Neither was identified.

Before the two operations this month, it had been nine months since the last AbioCor had been implanted.

The other living patient is Tom Christerson, who received his heart in September 2001 in Louisville.

The plastic-and-titanium heart is powered by batteries. It has no wires or tubes sticking through the skin, a technological leap from earlier mechanical hearts that were attached to machinery outside the body.

The surgery has been performed nine times in the United States, five times at Jewish Hospital. Some of the nine died during or shortly after surgery.

In July 2001, Robert Tools became the first person to receive the artificial heart, manufactured by Abiomed Inc. of Danvers, Mass. He died five months later.

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Strength Training Can Build Postmenopausal Bone

 

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - New findings add weight to the idea that postmenopausal women can boost their bone density with strength training.

In fact, the study found, the more weight women lifted over a year, the greater the increase in bone density, at least around the hip area.

The findings appear in the January issue of the journal Medicine & Science in Sports & Exercise.

Other research has pointed to the usefulness of weight-bearing exercise in cutting the risk of the brittle-bone disease osteoporosis after menopause. But many of these studies have been small, short or marred by design flaws, according to the authors of the new study.

To get around some of these shortcomings, the researchers followed 140 women, ages 44 to 66, who went through supervised strength training three times a week for one year.

All of the women took calcium supplements, and half were on hormone replacement therapy (HRT)--two tactics that protect bone density.

After one year, the women showed a bone-density boost in the femoral trochanter--the knobby end of the thigh bone near the hip--that increased in tandem with the total amount of weight they lifted over the study.

The effect was seen regardless of age, HRT use and bone density at the study's start, according to the researchers, led by Ellen C. Cussler of the University of Arizona in Tucson.

Bone density at certain other sites, including the lower spine, was not affected by the amount of weight the women lifted. The researchers speculate that the exercises may have placed more impact on the femoral trochanter, to which a number of muscles attach.

Certain exercises that target these muscles, like squatting with weights, appeared most effective at building bone density in the trochanter.

However, Cussler and her colleagues stop short of making specific recommendations on which weight-bearing exercises might best protect women's bones.

"Because the performance in one exercise may depend on success in others," they write, "a well-balanced strength-training program still provides the most sensible approach to an osteoporosis prevention program."

Source: Medicine & Science in Sports & Exercise 2003;35:10-17.

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FDA Issues Warning on Asthma Drug

The Associated Press

Thursday, January 23, 2003

WASHINGTON - The Food and Drug Administration (news - web sites) warned Thursday that some patients using a popular asthma medication are more likely to face life-threatening complications and more likely to die from their symptoms than those who are not taking the drug.

Officials emphasized that problems from the drug Serevent were rare, and they said the drug's benefits outweigh the risks. They cautioned that it is dangerous to abruptly stop taking the drug and recommended that concerned patients talk with their doctors.

Serevent, an aerosol spray made by GlaxoSmithKline, opens the airwaves to help asthma patients breathe more easily. Patients use it twice a day to prevent attacks.

Due to concerns about the drug, Glaxo launched a large study to compare the number of life-threatening experiences, such as intubations and mechanical ventilation, and the number of asthma-related deaths in patients taking the drug vs. the number of such occurrences in patients given a placebo.

The study found a greater risk of problems and a greater risk of death among black patients, and found a disparity in deaths among those who were not using a companion drug aimed at controlling inflammation.

As a result, the company and the FDA are emphasizing existing guidelines that say asthma patients whose disease is severe enough to require daily medication should also be using inhaled corticosteriods, which control inflammation.

"Someone who needs Serevent should be on something to control inflammation too," said Dr. Robert J. Meyer, director of one of the FDA's offices of drug evaluation.

The study was not designed to determine why certain Serevent patients were more likely to suffer problems, but rather to see if Serevent itself posed a threat, Meyer said.

The 28-week study included 26,000 patients. Originally designed to enroll 60,000 patients, Glaxo ended it early because of difficulty finding participants and because it was not designed to analyze the questions raised early in the study, company and FDA officials said.

When entering the study, 47 percent of all patients were using a corticosteroid. Black patients were less likely to be using these drugs than whites were, and that may explain at least part of why blacks using Serevent were more likely to have lung problems and more likely to die than whites were.

Officials at the company and the FDA did not know if other factors contributed to the racial disparities. Due to socioeconomic and other factors, blacks are more likely to face health problems. Overall, the severity of asthma is worse among blacks than whites.

Neither Glaxo nor FDA officials would say precisely how many people in each group had complications and how many died.

An estimated 16 million people in the United States have asthma, and about 1.3 million use Serevent.

The FDA approved Serevent, also known as salmeterol xinafoate, to treat asthma in 1994 and later extended its approval for treatment of chronic obstructive pulmonary disease.

On the Net:

FDA: http:/www.fda.gov

GlaxoSmithKline: http://www.gsk.com

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US Reports Jump in Stomach Virus Outbreaks

 

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - The virus best known for recently plaguing cruise ships is also causing a particularly high number of stomach-illness outbreaks on land this winter, US health officials reported on Thursday.

According to the US Centers for Disease Control and Prevention (news - web sites) (CDC), health departments in a number of states are reporting a "very noted" increase in infection with Norwalk-like virus, also called norovirus. Many of the outbreaks have occurred in nursing homes and hospitals, although schools and other closed public settings have been hit as well.

Norovirus is the most common cause of gastroenteritis in the US, and its symptoms--including diarrhea and vomiting--are unpleasant but rarely dangerous. The virus is transmitted through person-to-person contact, contaminated food or water, or by touching a contaminated surface.

Norovirus has been implicated in a number of recent illness outbreaks on cruise ships, but CDC officials say the rough going on the seas is a reflection of what's happening on land.

This year, a single new strain of norovirus--"provisionally" dubbed the Farmington Hills strain--appears to be responsible for many of the outbreaks states have reported to the CDC since last July.

Dr. Steve Monroe told a media briefing that this strain may be particularly easy to pass from person to person.

Monroe and his colleagues report outbreak data from three states in the January 24th issue of the CDC's Morbidity and Mortality Weekly Report.

In the last two months of 2002, they report, officials in Clark County, Washington, were notified of 10 gastroenteritis outbreaks that sickened 354 people, mainly in long-term care facilities.

In 2002, New Hampshire officials investigated 35 outbreaks "consistent with" norovirus, mainly in November and December. The outbreaks affected more than 2,300 people, again most often in nursing homes and assisted-living facilities.

And in New York City, 66 suspected norovirus outbreaks affecting about 1,700 people have been reported to officials since November.

Monroe said it's unclear why there's been a jump in norovirus infection, but added that "natural cyclic variation" in virus activity is likely at work.

He noted that a similar situation in which a single norovirus strain made a lot of people sick occurred in the 1995 to 1996 season in the US, Europe and elsewhere.

Both the UK and Canada have recently reported surges in norovirus infection, largely in nursing homes and hospitals.

Source: Morbidity and Mortality Weekly Report 2003;52:41-44.

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Cutting Calories Via Any Diet Regulates Hormones

 

By Alison McCook

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - Women with a hormonal problem that can lead to irregular periods and infertility experience an improvement in their symptoms after a few months of dieting, regardless of whether they opt for a low or high protein diet, researchers reported Thursday.

These findings suggest that for these women, what you eat is less important than how much you eat.

"The diet type is much less important than the actual restriction in calories," noted Dr. Sarah Berga of the University of Pittsburgh in Pennsylvania. Berga did not contribute to the current study, but she discussed the findings Thursday during a meeting of the American Medical Association here.

For years, some experts have recommended that people seeking to slim down opt for a low-fat diet, which is usually high in carbohydrates, since foods that are low in fat tend to be rich in carbohydrates.

However, accumulating evidence suggests that patients may also be able to shed pounds on a high protein diet, such as the Atkins Diet, which first gained popularity during the 1970s. Limited evidence suggests it may help people lose weight, but many experts remain concerned about the long-term health effects of the diet, since protein-rich foods often contains high levels of fat and cholesterol.

All of the women in the current study were overweight and had polycystic ovary syndrome (PCOS). This disorder, which can affect between 5% and 10% of menstruating women, is characterized by fertility problems, obesity, increased facial and body hair and a high risk of diabetes.

Researchers suspect that polycystic ovary syndrome is caused by an excess of male hormones in the body and by insulin resistance, a condition in which the body becomes less sensitive to insulin, and, in response, produces an excess of the key blood-sugar regulating hormone.

Just as the cause of the syndrome eludes experts, so do effective means of treating it. Doctors can treat the condition with drugs or surgery, but patients often prefer to manage their disorder through weight loss, a healthy diet and exercise.

In the current study, a group of Australian researchers led by L.J. Moran at the University of Adelaide and CSIRO Health Sciences and Nutrition assigned 45 overweight women with polycystic ovary syndrome to either high or low protein diets.

The researchers report their findings in the February issue of the Journal of Clinical Endocrinology & Metabolism.

The high protein and low carbohydrate diet consisted of 30% protein and 40% carbohydrates, while the low-fat, high carbohydrate diet included only 15% protein. The women were expected to eat a calorie-restricted diet--approximately 1,400 calories per day--for 12 weeks, then to spend another four weeks consuming enough calories to maintain, but not change, their body weight.

Study participants were also asked to exercise at least three times a week.

Only 14 women assigned to each diet were able to complete the entire program. Comparing the two groups, the authors discovered that both diets resulted in roughly the same amount of weight loss, and the same decrease in body fat and insulin levels.

Almost half of all participants improved the regularity of their periods, the authors note, and three out of 20 women trying to conceive did so during the study period.

None of the women reported any side effects from following the two diets.

"There were really very few differences" between the results from the two diets, Berga said. "It's nice to know that a little bit of dietary restriction can help," she added.

Source: Journal of Clinical Endocrinology & Metabolism 2003;88:812-819.

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Hemophilia Drug Cuts Prostate Surgery Blood Loss

 

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - A drug used by hemophilia patients may also cut blood loss in prostate cancer (news - web sites) patients undergoing surgery and reduce their chance of having a transfusion, new study findings suggest.

The drug is called factor VIIa, and it is sometimes used to treat hemophilia, an inherited disorder marked by uncontrolled bleeding due to a deficiency of clotting substances.

In the small study, 36 men with otherwise healthy blood-clotting systems were undergoing prostate removal surgery due to cancer or other causes. This procedure, in which the prostate is removed through an abdominal cut, often causes major blood loss and requires transfusions.

Dr. Philip W. Friederich of the University of Amsterdam in the Netherlands and colleagues publish their findings in the January 18th issue of The Lancet.

In the study, the patients received either one of two concentrations of factor VIIa or placebo at the start of the surgery.

At least half of the low- and high-dose factor VIIa groups lost at least 1,235 milliliters (mL) and 1,089 mL of blood, respectively. In the placebo group, at least half of patients lost 2,688 mL of blood.

More than half of the patients in the placebo group required a blood transfusion, the authors note. In contrast, none of the patients in the high-dose factor VIIa group and just over one third of patients in the low-dose group required a transfusion.

No adverse events were noted with factor VIIa therapy at either of the doses used, the investigators state.

The authors conclude that factor VIIa can cut blood loss and make blood transfusions unnecessary for patients having major surgery. The therapy could be particularly useful in cases where a patient is bleeding severely and it is difficult to block the blood flow surgically, they add.

Two of the study authors have been invited speakers at symposia organized by Novo Nordisk, a company that makes factor VIIa.

Source: The Lancet 2003;361:201-205.

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Need a Lot of Sleep? Blame It on Body Clock

 

By Merritt McKinney

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - If you feel like you need a lot more sleep than your peers, you may find the results of a new study comforting. The study suggests that the body's internal clock programs some people to sleep longer than others, researchers report.

This internal clock, or circadian rhythm, controls when we sleep and wake and plays a role in other biological processes as well, such as temperature regulation and hormone production.

In an interview with Reuters Health, Dr. Daniel Aeschbach explained that the body's internal clock creates a signal that divides the circadian cycle into two distinct periods--a biological day and a biological night.

During the biological night, we experience changes in hormone levels, body temperature and the propensity to sleep, explained Aeschbach, who was at the National Institute of Mental Health in Bethesda, Maryland, when the study was conducted.

"Somehow the clock programs an internal night during which it favors rest and sleep," said Aeschbach, who is now at Brigham and Women's Hospital and Harvard Medical School (news - web sites) in Boston, Massachusetts.

Although most adults average 7.5 hours of sleep a night, some people get by on less sleep while others seem to need more z's. Researchers suspect that there is a physiological explanation for sleep differences, but exactly what this might be has been uncertain.

In the study, Aeschbach and his colleagues compared long sleepers, who usually slept more than nine hours a night, and short sleepers, who usually got less than six hours a night. Participants were kept awake in a sleep lab for 40 hours so that both long and short sleepers would be living under the same conditions.

Based on several measures, including hormone levels, body temperature and sleepiness, long sleepers had a longer biological night than short sleepers. "This means that there are differences in internal circadian signals," Aeschbach said.

The findings are reported in the January issue of the Journal of Clinical Endocrinology and Metabolism.

These differences, the Boston researcher noted, could help account for variations in the amount people sleep. The fact that the length of the biological night seems to vary from person to person may also help explain why it is difficult to change sleep habits willfully, he added.

What causes the differences remains unknown, however, according to the Boston researcher. Genetics and behavior are two possible explanations, he said.

The results of the study support the idea that sleep needs vary from person to person, Dr. Scott A. Rivkees of Yale University in New Haven, Connecticut, states in an editorial that accompanies the study.

Noting that "we seem to value our alarm clocks more than our internal clocks," Rivkees suggests that our society needs to find a way to accommodate each person's individual sleep requirements.

Source: Journal of Clinical Endocrinology and Metabolism 2003;88:24-30.

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Pot-Like Brain Compounds Affect Drinking Desires

 

By Merritt McKinney

Reuters Health

Thursday, January 23, 2003

NEW YORK (Reuters Health) - Molecules in the brain that are similar to the active ingredient in marijuana may be involved in controlling how much alcohol a person drinks, researchers report.

Mice that lacked the brain receptors for these molecules or that had been treated with a drug that blocked them were much less likely to drink than normal mice.

Besides providing more information on how the brain controls the desire to drink, the research suggests that blocking these receptors, known as CB1 receptors, may be a promising way to help people with drinking problems, according to Dr. George Kunos.

"The CB1-receptor-blocking drug used in the study may be effective in reducing the rewarding effects of drinking and thus the desire to drink in alcoholics and heavy drinkers," Kunos, who is at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, told Reuters Health.

Kunos said that the National Institutes of Health (news - web sites), in collaboration with the French pharmaceutical company Sanofi-Synthelabo, is in the process of setting up a clinical trial to study the effect of the CB1-blocking drug. Sanofi-Synthelabo makes the drug, which is known as Rimonabant.

Marijuana produces a high as chemicals in the drug latch on to receptors in the body, including CB1 receptors in the brain. In the early 1990s, scientists discovered that the body has molecules of its own that attach to these receptors. The molecules, known as endocannabinoids, seem to be involved in controlling several different processes in the body, including appetite and how much we eat.

Now, two sets of researchers report that endocannabinoids appear to be involved in controlling alcohol consumption, too. Kunos and his colleagues report their findings in the online edition of the journal Proceedings of the National Academy of Sciences (news - web sites). Another team, led by Dr. Basalingappa L. Hungund of the New York State Psychiatric Institute in Orangeburg, has a report on the CB1 receptor-alcohol relationship in the Journal of Neurochemistry.

The research provides "unequivocal evidence" that endocannabinoids and CB1 play a role in alcohol drinking, Kunos and his colleagues conclude.

Young mice that were genetically engineered to lack CB1 receptors were much less likely to drink than normal young mice. Similarly, the CB1-blocking drug reduced drinking in normal mice but not in animals without the receptors.

The other set of researchers found that the lack of CB1 receptors did more than only make mice drink less. The absence of the receptor kept mice from releasing the pleasure-related brain chemical dopamine after they drank alcohol.

In a related finding, Kunos and his colleagues observed that in older mice, CB1 signaling was diminished in the part of the brain that releases dopamine in response to alcohol consumption.

This could explain why mice's appetites for not only food but also alcohol declined with age, according to Kunos.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0336351100. Journal of Neurochemistry 2003;24.

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WEDNESDAY, JANUARY 22, 2003 

Too Much Vitamin A Boosts Risk of Broken Bones

 

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - Men in their 40s and 50s who have the highest blood levels of vitamin A are more likely to break a bone in their old age than their peers with lower levels, according to a Swedish study released Wednesday.

The results--which confirm two other studies in women--suggest that some people may be getting too much of a good thing via supplements and fortified food, the study's authors say.

They believe that "current levels of vitamin A supplementation and food fortification in many Western countries may need to be reassessed," according to the report.

Dr. Karl Michaelsson of University Hospital in Uppsala, Sweden and colleagues looked at 2,322 men aged 49 to 51 and followed them for 30 years. Men with the highest blood levels of vitamin A at the beginning of the study were 1.6 times as likely to break a bone as men with an average amount of vitamin A in their blood. When it came to breaking a hip, those with elevated vitamin A had a 2.5-fold greater risk than men with lower levels of vitamin A. Overall, 266 men broke a bone during the study.

There was no link between blood levels of beta-carotene, a compound that is converted to vitamin A in the body, and fracture risk, according to the report in the January 23rd issue of the New England Journal of Medicine (news - web sites).

Vitamin A is found in fish liver oils, liver, kidney and milk. It is sometimes added to dairy products, which in Sweden includes margarine and low-fat dairy products.

While vitamin A is necessary for growth, vision, reproduction and a healthy immune system, too much vitamin A has long been known to be dangerous. Taking too much vitamin A (25,000 IU to 50,000 IU per day or more) over long periods can cause bone and joint pain, loss of appetite, nausea, vomiting and weight loss.

And a single extremely high dose can cause drowsiness, irritability, headache, vomiting and widespread peeling off of the skin.

In an accompanying editorial, Dr. Paul Lips of Vrije Universiteit Medical Center in Amsterdam, The Netherlands, notes that blood levels of vitamin A tend to increase with age, probably because it takes longer to clear from the body.

The risk of too little vitamin A is greatest in malnourished children and the risk of too much is greatest for adults--especially older people, Lips notes.

The current study "suggests that vitamin A supplementation and fortification of food with vitamin A may be harmful in Western countries, where the life expectancy is high and the prevalence for osteoporosis is increasing."

Source: The New England Journal of Medicine 2003;348:287-294,347-349.

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Domestic Violence Victims See Doctor More Often

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- Women who are victims of physical or sexual domestic violence visit their doctors more often than other women.

That trend was pinpointed in a new study in the January issue of the American Journal of Preventive Medicine.

The researchers examined medical records from 1997 to 2002 of several groups of adult female patients of Group Health Cooperative (GHC), an HMO in Seattle.

One group included 62 women who were documented domestic violence victims who visited a doctor for a physical examination or to treat an injury, chronic pelvis pain or depression.

A second group included 2,000 women who saw a doctor for the same complaints, but who were not documented victims of domestic abuse. The third group included more than 6,000 women drawn from the general GHC patient population.

The study found the domestic violence victims averaged more than 17 doctor visits a year, compared to an average of 10 visits for the second group and an average of six visits for the third group.

The study also found that 27 percent of the domestic violence victims had more than 20 doctor visits a year.

Annual health-care costs were significantly higher for the women who were victims of domestic violence. Their health-care costs averaged more than $5,000 per year, compared to about $3,400 for those in the second group and $2,400 for those in the third group.

More information

Here's where you can find out more about domestic violence.

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Antioxidant-Amino Acid Mix Shields Blood Vessels

 

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - A cocktail of antioxidants mixed with an amino acid may protect blood vessels from inflammation and the buildup of plaque, a preliminary study suggests.

According to the report, antioxidants and L-arginine, an amino acid, protected the cells of human blood vessels from the wear and tear of fluid rushing by.

Branch points, areas where two vessels meet, are particularly vulnerable because they are exposed to turbulent shear-stress, a type of force imposed by the flow of blood that can cause inflammation and plaque build up leading to atherosclerosis, or hardening of the arteries.

Shear-stress can also increase damage from free radicals, compounds that can cause varying degrees of damage to cells, researchers report in the online early edition of the Proceedings of the National Academy of Sciences (news - web sites).

To investigate if antioxidants and L-arginine might prevent this type of damage, researchers exposed human cells to different fluid flow forces inside a culture dish.

High shear-stress caused cells to produce inflammatory compounds. However, fewer dangerous compounds were produced when cells were coated with antioxidants and L-arginine. These substances also caused the cells to produce eNOS (endothelial nitric oxide synthase), an enzyme that allows vessels to expand and prevents blood from clotting.

Antioxidants have been shown to squelch free radicals while L-arginine is a precursor of nitric oxide, a compound that helps the inner lining of blood vessels to dilate.

In a second experiment, researchers demonstrated that these compounds reduced the damage caused by shear-stress in mice bred to have high cholesterol.

"These results demonstrate that atherogenic effects induced by turbulent shear-stress can be prevented by co-treatment with antioxidants and L-arginine," Dr. Louis J. Ignarro from the University of California in Los Angeles and colleagues conclude.

Source: Proceedings of the National Academy of Sciences 2003;10.1073

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Help Prevent Colic Attacks

HealthScoutNews

Wednesday, January 22, 2003

(HealthScoutNews) -- No one knows for sure why some babies get colic, but parents definitely know when their infant is having a colic attack. The wailing is incessant and nothing seems to soothe a colicky child.

The University of Michigan suggests how you might ward off a colic episode:

If you're bottle-feeding:

  • Have your baby sit up while feeding. This will reduce the amount of air your infant swallows.
  • Don't make the milk or formula too hot.
  • Check the nipple on the bottle. If the hole is too small, your baby will swallow air.
  • Try a new formula.

If you're breast-feeding:

  • Drink less cola, coffee, cocoa, and tea.
  • Stay off milk products for a week and note any difference in your baby's discomfort.

Whether you're breast- or bottle-feeding, try to keep the room quiet when you feed your baby.

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Early Menopause Not Always 'Unnatural': Study

 

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - Early menopause among women who have not had a hysterectomy or other type of gynecologic surgery may not be as unnatural as some women think, study findings suggest.

"Our results indicate some difference between lay perceptions and those of health professionals and researchers in what constitutes a 'natural' menopause," write lead study author Debbie A. Lawlor of the University of Bristol in the UK and her colleagues.

Their findings are based on survey responses from more than 3,000 British women aged 60 to 79 who were involved in the British Women's Heart and Health Study. Most of the women said their periods had stopped naturally, when they were about 51.5 years old.

One in five women, however, said they had experienced an "unnatural" stop to their monthly menstrual cycle and 84% of them gave a reason why, the researchers report in a recent issue of the British Journal of Obstetrics and Gynecology.

In most (95%) cases, women attributed their early menopause to some type of gynecologic operation, primarily hysterectomy and/or ovary-removal surgery. Yet a few women cited breast cancer (news - web sites) and/or its treatment as a reason for their "unnatural" menopause, and some others cited bereavement, divorce and other major life events.

Women who had a hysterectomy or who underwent surgery to remove their ovaries and those who said they had been through a major life event experienced menopause at similar ages, in their late 40s, roughly six years earlier than women who reported natural menopause.

Women who went through other gynecologic operations, and those who cited breast cancer as a reason for their early menopause, began menopause about two and three years earlier, respectively.

It is possible that major life events trigger early menopause due to the influence of hormone-related changes, the researchers write. Previous studies have also found that women who experienced separation, widowhood and divorce reported menopause at earlier ages than women who had not gone through such events.

In some cases, however, women may attempt to link a major life event or other experience to their early menopause when no such link actually exists, according to the researchers. Some women whose menopause occurred early may see it as "unnatural" and may search for a reason why, they say.

"Women who experience what is probably a 'natural' menopause (from a medical perspective) but at an earlier age than average may perceive this to be unnatural (rather than a variation of normal) and therefore search for an explanation for its occurrence," the researchers conclude.

The British Women's Heart and Health Study is funded by the UK Department of Health.

Source: British Journal of Obstetrics and Gynaecology 2002;109:1398-1400.

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Bipolar Disorder More Common Than Previously Believed

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- Three times as many Americans may suffer from bipolar disorder than previously believed, says a nationwide study that appears in the January issue of the Journal of Clinical Psychiatry.

The study of more than 85,000 Americans shows that nearly 4 percent, 2.3 million Americans, may be affected by bipolar disorder. Previous studies suggest that rate may be 1 percent.

The study findings also indicate that as many as 80 percent of those who screened positive for bipolar disorder, also known as manic depression, hadn't been diagnosed with the illness, and nearly one-third had been misdiagnosed with major depression.

The results emphasize the need for early detection and accurate diagnosis of bipolar disorder.

The study data indicate that bipolar disorder may be most common among young adults, ages 18-24, and people with lower incomes.

The study also found that 19 percent of people who screened positive for bipolar disorder reported significant alcohol or drug abuse. And people who screened positive for the disorder had significantly higher rates of other health problems such as allergies, asthma and migraine.

For this study, researchers mailed the Mood Disorder Questionnaire (MDQ) to 127,800 American adults and received 85,358 returned questionnaires. The MDQ is a validated screening tool for bipolar disorder.

Bipolar disorder is a lifelong, potentially fatal illness. It's often characterized by distressing and disruptive mood swings from high (manic) to low (depressed) states. Suicide is the most serious risk of bipolar disorder.

More information

Here's where you can learn more about bipolar disorder.

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Feedback Technique May Boost Memory: Study

 

By Stephen Pincock

Reuters Health

Wednesday, January 22, 2003

LONDON (Reuters Health) - British scientists may have enhanced the working memory of medical students by using "neurofeedback," a technique researchers think might also help some people with hyperactivity, epilepsy and alcoholism.

Neurofeedback trains people to alter their brain activity to enhance specific frequencies of activity while subduing others. Signals picked up by an EEG sensor on the scalp are fed back to the individual in the form of a video game displayed on a computer screen. The participant learns to control the game by altering particular aspects of brain activity.

"What it takes is a relaxed and focused attention," researcher Dr. David Vernon told Reuters Health. "You have to use the feedback to guide you. If you start scoring, think about what is happening in your body and that's the state you want to be in."

In a study of 40 medical students, Vernon and colleagues from Imperial College London found that after two 15-minute neurofeedback sessions a week for four weeks, a subset of the students were able to boost their "sensorimotor rhythm" (SMR) activity, a type of brain wave activity.

"These people were able to change their EEG profile and were able to enhance their SMR activity," Vernon said. "Whether that was permanent or not I don't know."

The participants trained to improve this SMR brain activity also saw an improved recall of a series of words, from an average of 71% before the neurofeedback training to 82% afterwards.

"This is the first time we have shown a link between the use of neurofeedback and improvements in memory," said Vernon, whose group reports their findings this month in the International Journal of Psychophysiology.

"Whether this was a causal relationship or whether it was just some sort of association, it is too early to tell," he cautioned. Other participants, who were trained to enhance different brain activity frequencies, did not show a significant increase in recall.

Clinical research from the US has shown that the technique can benefit children with attention-deficit hyperactivity disorder, people with epilepsy, and possibly even be used as a complementary therapy for substance abuse such as alcoholism, he said.

Professor John Gruzelier, another researcher who took part in the study, said neurofeedback had been proven to be effective in altering brain activity, but the extent to which this can influence behavior is still unknown.

"Further tests are needed to confirm this, but if neurofeedback can positively influence the cognitive performance of healthy individuals, as we have previously shown on attention and musical performance, it opens up the possibility that such treatment may be beneficial for those suffering from cognitive deficits."

Source: International Journal of Psychophysiology 2003;47:75-85.

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Blockage Can Be Death Knell in Heart Condition

 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- If a patient with the heart condition called hypertrophic cardiomyopathy has an obstruction that limits blood flow from the left ventricle, the risk of heart failure and death increases considerably, a new study says.

This may seem like an esoteric finding, of interest only to cardiologists, but it is actually a matter of life or death to the hundreds of thousands of Americans with the condition. Hypertrophic cardiomyopathy is the most common genetic heart disease, occurring in one out of every 500 Americans, and there has been a running debate in the cardiology community about the danger of left ventricular obstruction since the condition was first identified in the 1950s.

This study settles that debate, says lead author Dr. Martin S. Maron, a cardiology fellow at the Tufts-New England Hypertrophic Cardiomyopathy Center in Boston. His report appears in the Jan. 23 issue of The New England Journal of Medicine (news - web sites).

"The study clearly shows that obstruction directly impacts progression to heart failure and death," Maron says. "We have shown for the first time that this is true."

Both Maron and Dr. Mark V. Sherrid, director of the hypertrophic cardiomyopathy center at St. Luke's- Roosevelt Hospital Center in New York City, say the study will change the way the condition is treated.

Intervention to reduce the obstruction and increase the flow of blood from the ventricle, which pumps blood to the body, will come sooner in many cases, they explain.

Hypertrophic cardiomyopathy is an abnormal thickening of the heart muscle that occurs irregularly in different parts of the heart. It can occur at any age; many of the sudden deaths of young athletes are caused by it. In a large percentage of cases, the heart becomes distorted enough so that the flow of blood from the left ventricle is obstructed and reduced.

The study, done at a number of medical centers, looked at 1,101 patients, of whom 273 had left ventricular obstruction. It found the risk of heart failure and death in patients with obstruction was more than four times greater than in those without obstruction, with the risk higher in older patients.

For those patients, Sherrid says, the first option for treatment is therapy with drugs such as disopyramide, a medication that controls the heartbeat.

"Of all the medical treatments, disopyramide is the single most effective," he says. Other heart drugs, such as beta blockers and calcium antagonists, may also be used.

If drug treatment doesn't work, there are two alternatives. One is surgery to widen the passage out of the atrium. Another, and more controversial, method is alcohol ablation, in which alcohol is directed to a specific part of the heart. Alcohol kills heart cells, Maron notes, and this is "a limited, controlled heart attack in the area where the thickening is occurring." It was introduced only five years ago, and "most people think surgery is the gold standard," he says.

"You can infer from our study that these patients should be offered these procedures earlier in the course of the disease rather than later," Maron says, but he adds the study leaves some questions unanswered.

Specifically, it does not show that early intervention improves the prognosis for these patients. Another, completely different study must be done to show that, Maron adds.

More information

You can learn more about hypertrophic cardiomyopathy from the National Institutes of Health or the Hypertrophic Cardiomyopathy Association.

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Weight Loss Surgery Changes Food Preferences

 

By Alison McCook

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - People who undergo weight-loss surgery appear to experience shifts in their food preferences, feeling less desire to eat food in general and, in particular, to eat certain foods including sweets, butter and starches, researchers said Monday.

This shift in food preferences did not result from changes in how sensitive patients were to certain tastes, according to the study's authors.

Changes in taste sensitivity can influence food preferences. For example, people who become more sensitive to sweet tastes may find less-sweet foods just as tasty as highly sweetened treats had been before. A heightened sensitivity to sweet, therefore, could prompt patients to cut back on their former sweet indulgences.

The findings are based on results from 27 patients who planned to undergo a type of gastric surgery known as Roux-en-Y, in which a surgeon creates a small pouch in the stomach and also bypasses a portion of the small intestine.

Afterwards, patients tend to eat less--and lose weight--because they feel full on less food. Also, fewer calories are absorbed since some of the intestine is bypassed.

Before the patients underwent surgery, Dr. Alison G. Hoppin and her colleagues at the Massachusetts General Hospital Weight Center in Boston asked patients to indicate how often they ate certain foods, and administered a test that measures taste sensitivity.

During the tests of taste sensitivity, study participants sampled a series of liquids that contained different concentrations of the four basic tastes: sweet, sour, salty and bitter. The patients then rated how strong each concentration was on a taste scale.

Two months after the surgeries, Hoppin and her colleagues repeated the taste tests, and asked participants to again indicate how often they ate certain foods.

The patients reported wanting to eat more fruits and vegetables and a reduced desire for sweets, the researchers reported Monday during a meeting of the American Society for Parenteral and Enteral Nutrition in San Antonio, Texas.

In an interview with Reuters Health, Hoppin said she and her colleagues were not sure why patients changed their preferences for certain foods, without showing changes in taste sensitivity.

Patients said they were less hungry, she noted, and feeling less hungry might cause them to opt for lighter fare.

Hoppin added that there may be some underlying body changes that researchers have yet to uncover that explain why patients' food preferences change. For instance, she noted that the body of a person who has undergone gastric surgery is much different from the body of a dieter--specifically, dieters often say they still feel hungry once they cut back on certain foods, while surgery patients report dramatic drops in hunger.

"I think there is probably some underlying physiology that is not yet explained," Hoppin said.

She added that she and her colleagues plan to repeat the taste sensitivity tests and the food preferences questionnaire in the same patients one year after their surgeries, once their rate of weight loss has slowed.

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TV Soothes Low Self-Esteem

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- Turning on your television could be one way to tune out static about your self-image.

Researchers at the University of Pennsylvania and the University of British Columbia found that switching on the tube helps distract people from their personal failings.

The study, which appears in the January issue of the Personality and Social Psychology Bulletin, examined the TV viewing habits of undergraduate students after they received either positive or negative results on an intelligence test.

The students who received low scores watched television longer and waited longer before the first instance of averting their eyes from the television than students who had high scores.

The students with poor results watched television for 4.03 minutes out of a possible 6 minutes and did not avert their gaze for the first 72 seconds. The students who scored well on the test watched television for 2.46 minutes out of a possible 6 minutes and first looked away from the television after 11 seconds.

The study also found the students perceived less challenge to their chosen self-image after they watched television. That was true whether they watched an image of a waterfall accompanied by soft classical music or more evocative images accompanied by sad music.

More information

Much attention is given to how television affects us. This site discusses children and violence on television.

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Junk Food Diet Brings Scurvy to Modern Age

 

By Alison McCook

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - A diet completely lacking in fruits and vegetables caused a young college student to develop a condition linked to a low intake of vitamin C, US researchers reported Tuesday.

The young man developed scurvy even though he was eating plenty of calories and had no deficiencies in most other vitamins and minerals. Scurvy, a disease characterized by bleeding gums, loose teeth, muscle degeneration and weakness, was once the scourge of sailors, who found that sucking on a lime could keep the disease at bay.

The student confessed to doctors that he ate no fruits and vegetables, consuming only a few types of foods--namely, cheese, crackers, soda, cookies, chocolate and water.

Based on the patient's diet, researchers estimate he was taking in around 0.1 milligram of vitamin C per day. The current recommended daily allowance (RDA) for vitamin C for nonsmoking men is 90 milligrams per day.

This case demonstrates that even seemingly healthy people can develop a deficiency in vitamin C, study author Barbara Hermreck of the Lawrence Memorial Hospital in Kansas told Reuters Health.

Just because people eat enough food, "that doesn't mean that it's a given that they are getting enough vitamin C," she said.

Hermreck added that the student would have needed to take in only minimal amounts of vitamin C to offset his risk of developing scurvy. She estimated that most men and women could meet their daily vitamin C needs with only one four- to eight-ounce glass of orange juice.

"It doesn't take much orange juice to keep it from being a problem," she said.

She and her colleagues presented the case Tuesday during a meeting of the American Society for Parenteral and Enteral Nutrition in San Antonio, Texas.

Scurvy is a relatively uncommon condition, Hermreck explained, although it tends to pop up more often among the elderly or alcoholics, who tend to have highly unbalanced diets. However, previous research has suggested that many Americans have relatively low levels of vitamin C in their blood, but the deficiencies are not extreme enough to develop into scurvy.

Smoking cigarettes and feeling stressed can also boost vitamin C needs, Hermreck noted.

The patient featured in the current case study visited a doctor because he was experiencing swelling and bruising on his legs. Hermreck explained that one of the signs of scurvy is a change in skin color on the legs, a result of bleeding underneath the skin.

A further examination showed the patient had bleeding gums and a rapid heartbeat.

The patient was diagnosed with scurvy after he revealed his eating habits and blood samples showed levels of vitamin C that were at least four-fold below normal range.

After only four days of taking a multivitamin and a vitamin C supplement, the bruising and discoloration in the patient's legs had almost disappeared, his gums had ceased to bleed and his heart rate decreased. Another two weeks of extra vitamin C improved his condition even further, Hermreck noted.

"It was just a number of days" before the patient began to improve with extra vitamin C, she said.

People need vitamin C every day, Hermreck added. However, she said she believed that clinical signs of scurvy would not appear until after between one and three months of a consistently low intake of vitamin C, such as less than five milligrams per day.

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Lasers Zap Varicose Veins for Good

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- Laser therapy to treat varicose veins produces better results than surgery or other kinds of treatments, according to new research.

A two-year follow-up of 97 people treated with endovenous laser treatment (ELVT) found varicose veins recurred in 6 percent of the people. That compares to a recurrence rate of 10 percent or more in people who have surgery or other treatments such as injection of chemical solution or radiofrequency energy. The findings were presented this week at the 15th Annual International Symposium on Endovascular Therapy in Miami Beach, Fla.

In this study, 414 limbs on 364 people were treated in a 37-month period. The people were evaluated with ultrasound at one week, one month, six months, one year and then annually to assess the success of the laser treatment.

Varicose veins along the back or inside of the leg affect about half the women 50 or older in the United States and about 10 percent to 15 percent of men.

Not only are they unsightly, varicose veins can cause discomfort, leg muscle fatigue, swelling, throbbing, cramping at night, and itching or burning of the skin on the leg and around the ankle.

Severe varicose veins can cause chronic venous insufficiency. That's a condition where blood doesn't completely return to the heart from the veins. That may cause swelling of the legs or skin alteration.

More information

Here's where you can learn more about varicose veins.

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Big Increases Seen in '03 U.S. Bio-Corn, Soy Crops

 

By Christopher Doering

Reuters

Wednesday, January 22, 2003

WASHINGTON (Reuters) - American farmers are poised to boost plantings of biotech corn by nearly 10% this year amid growing US pressure on the European Union (news - web sites) to lift a ban on imports of genetically modified crops, according to a Reuters survey released on Wednesday.

The straw poll of 340 growers, conducted at the American Farm Bureau (news - web sites) Federation's annual meeting, found US farmers want to plant more gene-spliced corn despite opposition from large customers such as the EU and Japan. Consumers in those countries have expressed concerns about long-term health and environmental impacts.

US 2003 plantings for Roundup Ready corn will jump by 9.9% and Roundup Ready soybeans by 8.4%, according to growers surveyed at the meeting of the nation's largest farm group. Roundup Ready crops are engineered so growers can use a single herbicide to kill weeds.

However, Bt corn plantings posted the only decline among the five major biotech crops included on the survey, falling 3.8%. Bt crops contain a gene that repels a destructive pest while the young plant is growing. Bt corn acreage fluctuates with European corn borer infestations.

Gene-altered cotton plantings will also rise in 2003, according to the survey.

Roundup Ready cotton plantings will be up 4%, while Bt cotton will rise by 5.2%, according to farmers polled at the meeting.

The Reuters survey was based on random, personal interviews at the meeting, and does not weight responses by state, size or other criteria. The results provide an early indication of whether farmers will plant more or less genetically modified crops than the previous year.

Total Biotech Plantings Rise

In recent years, growth in some biotech plantings have begun to slow as many US farmers have already adopted the new technology.

Overall, biotech plantings across all US crops will rise by 2.3%, according to farmers surveyed in the Reuters poll. That marks a slowdown from the rapid increases logged in the first years after the new crops were introduced to US farmers in 1996.

According to US Agriculture Department (news - web sites) data, 34% of corn in 2002 was grown with biotech seeds, up from 26% a year earlier. Biotech soybeans rose to 75% of the total US soybean crop in 2002, up from 68% in the previous year.

Biotech cotton accounted for 71% of the crop in 2002, up 2% from 2001, according to the USDA.

The US government has repeatedly endorsed the safety of biotech crops now on the market. But despite American farmers' embrace of gene-spliced crops, questions remain whether the world will be eager to buy them.

The discovery that 1,200 tons of US corn shipped to Japan last month may have been contaminated with StarLink has rekindled Asian concern. In 2000, taco shells and other corn-based foods were recalled after StarLink, a biotech corn variety approved only for animal feed, was discovered in the US food supply.

EU On The Hot Seat

US Trade Representative Robert Zoellick said this month Washington was prepared to ask the World Trade Organization (news - web sites) to pressure the EU to lift its moratorium blocking imports of biotech foods.

"Our patience has worn thin," echoed Bob Stallman, president of the Farm Bureau. "Until you take a case to the WTO, there isn't any other way to solve this issue."

US farmers surveyed said the EU moratorium has cost them hundreds of millions of dollars in sales.

"When it affects prices it affects your bottom line," said Kendell Culp, an Indiana corn and soybean farmer. The EU needs to "get a better policy" that is not dependent on consumers' unfounded worries, he added.

The European Union has banned the approval of gene-spliced crops since 1998, when France and other members demanded that there first be tougher rules in place for testing and tracking biotech products.

Some US farmers contend such rules would be costly and unnecessary. The Reuters poll found that 43% of farmers said they could not comply with new rules requiring more record-keeping. However, some growers surveyed said that kind of paperwork would add a few cents a bushel to their production costs.

"It would be cost prohibitive, and there is no incentive (for farmers) to do that," said Delmer Keiser, a Kansas corn, soybean and wheat farmer.

The survey also showed that 58% of farmers interviewed would plant biotech wheat crops when they becomes available. More than half of those who do not plan to grow biotech wheat said it is because they do not reside in a wheat-growing part of the country.

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Tots Tune Into TV

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 22, 2003

WEDNESDAY, Jan. 22 (HealthScoutNews) -- You can teach your 1-year-old to choose one toy over another by showing a negative emotion about the toy you don't want her to touch.

So, too, can your television set.

In a study to determine when babies begin to understand that emotional connections are about "things" -- such as the fact that someone's happy response to a blue ball means that the ball itself is what is making them smile -- a Tufts University psychologist discovered that 12-month-old babies responded to negative emotions shown about certain toys while 10-month-old babies did not.

However, what she also learned was that this teaching worked when the children watched it on television. They responded to an actress on television just as they would to a live person in the room with them.

"They were able to watch something on television and actually use the information to make decisions themselves and guide their behavior," says Donna Mumme, the Tufts psychologist and lead author of the study, which appears in the January/February issue of Child Development.

"The study was done in a controlled environment with no other distractions, and I don't know how [the findings] would generalize to the home environment. But parents may want to think twice about what's on the television for their 1-year-old," she says.

"This study shows how precociously sensitive babies are to emotional cues. Facial expressions and tones of voice are fairly subtle," says Dara Musher-Eizenman, a psychologist at Ohio's Bowling Green State University.

"Further, the cues that the infants are responding to are available on the television," she adds. "It's surprising that they don't need a real interaction."

Infants spend much of the time when they are awake watching the actions and reactions of people around them, including on television, Mumme says. Her research is aimed at how babies process the information they take in.

She and colleague Anne Fernald of Stanford University conducted two studies, one of 32 babies aged 10 months and the second of 32 babies aged 12 months.

For each group, the researchers gave the babies toys to play with, including a blue ball, a red spiral letter holder, and a yellow garden hose attachment. The infants then watched a videotape of an actress playing with the same objects. The actress responded positively, neutrally, or negatively to each object. Her visual and audio responses were based on accepted research standards established to record emotions.

After watching the video, the babies were then given the objects again. The 10-month-old babies were not influenced by the video, and played with the objects the same way they had before, but the 12-month babies did respond to the video Mumme found.

If the actress responded positively or neutrally to the objects, the older infants played happily with them. However, after observing the actress respond negatively to an object, the 12-month-old infants all chose to avoid playing with it and chose instead the other one offered to them.

"These infants were not a part of the interactions, but even watching the emotions they were still able to use the information," Mumme says.

Mumme says there could be several reasons why the 10-month-old babies didn't respond to the video.

"Maybe it was because the demonstration was on television, or maybe there is a developmental difference between them and the 12-month olds," she says. "There might be some underlying cognitive development necessary. For instance, you need to follow the person's gaze, and these babies might not have that skill."

Mumme is now studying how long infants are affected by what they see on television.

"We're looking at whether infants remember what was on television. If you put a delay in the study, would they still remember?" she says.

In the meantime, Mumme suggests parents not underestimate how well babies can pick up emotional signals.

"If you're anxious about a doctor's visit for your 12-month-old, you might not want to show it. A baby could pick up on that," she says.

More information

Read the American Academy of Pediatrics policy statement recommending no television for children under 2. Information about the effect of TV violence on children can be found at the American Psychological Association.

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Red Dye Helps Huntington's-Like Disease in Mice

 

By Alison McCook

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - Researchers have successfully rid mice of a neurodegenerative condition similar to Huntington's disease using a laboratory dye that just happens to dissolve clumps of abnormal proteins in the brain.

This finding validates the theory that neurological diseases can result from protein clusters in the brain, but the dye is unlikely to end up as a treatment for humans.

A similar procedure would be difficult in humans, Dr. Junying Yuan explained, because the dye--Congo red--does not cross the "blood-brain barrier," which shields the brain from contact with body substances. She and her colleagues administered Congo red to mice using a pump system that would be too difficult for humans, Yuan noted.

Mice were killed soon after they received Congo red, she added. If they had lived longer, she said she suspected the protein clumps would have returned in their brains, and they would have needed another dose of Congo red to regain their health.

In the future, companies may develop a treatment that performs the same function as Congo red, and can cross freely from the blood into the brain, Yuan predicted.

The finding does point the way toward new therapies that reverse neurodegeneration by disabling the clumps that cause it.

"Abnormal protein aggregates are neurotoxic, and should be a target for future therapies," Yuan, of Harvard University in Boston, Massachusetts, told Reuters Health.

All of the mice in the current study had a condition that resembled Huntington's disease, a fatal hereditary condition in humans that causes certain cells in the brain to become dysfunctional and eventually die.

Yuan said that experts suspect Huntington's disease stems from a genetic abnormality that causes cells to produce too many copies of an amino acid called glutamine, one of the building blocks of proteins. Proteins that carry excess copies of the amino acid form clumps.

In the current study, reported in the January 23rd issue of Nature, Yuan and her colleagues manipulated human cells so that they would produce extra copies of glutamine. The researchers then added Congo red, which experts use to detect protein clusters in the brains of people who have died.

However, in the context of living cells filled with clumps of proteins that contain abnormal amounts of glutamine, Yuan and her team discovered that Congo red inserts itself into part of the protein aggregates and dissolves them. This action prevented cells from dying, Yuan noted.

In an interview, Yuan explained that Congo red identifies but does not dissolve protein clumps in the brains of the deceased because those organs have been placed in formalin, a fixative that preserves the brain and prevents its proteins from being degraded.

To test whether Congo red helps dissolve protein clumps in the brains of live animals, the researchers engineered mice to develop Huntington's disease. After the mice developed symptoms of the condition, Yuan and her colleagues injected them with Congo red and watched as their symptoms improved.

The researchers then killed the mice, examined their brains, and found that the clumps of proteins that signal Huntington's disease had disappeared.

Source: Nature 2003;421:373-379.

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Mopping Up Lead from Body Helps Ailing Kidneys

 

By Amy Norton

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - Low-level exposure to lead in the environment may contribute to chronic kidney failure in some people, according to a study released Wednesday.

Taiwanese researchers found that among patients with chronic kidney disease, those with higher lead levels in their bodies at the study's start were at greater risk of seeing their disease progress.

Moreover, they report, removing lead from patients with levels at the high end of normal improved some kidney function.

The findings are published in the January 23rd issue of The New England Journal of Medicine (news - web sites).

It's known that high lead levels in the body can damage the brain and nervous system, red blood cells and kidneys. Lead poses a particular risk to children, because chronic exposure to even low levels can damage the nervous system and lead to learning and behavioral problems.

But whether low-level exposure to environmental lead can, over time, promote kidney disease is less clear.

And the new study cannot yet answer that question, according to Dr. Philip A. Marsden, of the University of Toronto in Canada.

In an interview with Reuters Health, he explained that people with chronic kidney disease may be more vulnerable to accumulating higher-than-average levels of lead, possibly because they cannot efficiently clear the metal from their blood.

In addition, Marsden said, it's not clear how widely applicable the findings from the Taiwanese patients are, since their everyday lead exposure may be higher than that of people in North America and Europe, for example.

Lead is present throughout the environment--in the soil, water and air--but individuals' exposure varies. In the US, the lead-based paints still found in many older homes are a major source of lead exposure. Drinking water is another potential source, particularly when a home has old, lead-based pipes.

In North America, Marsden noted, the main concern is for children in inner cities, who are more likely to be exposed to lead at home.

What's "very key" about the new study is that it brings kidney disease patients to everyone's attention, according to Marsden, who wrote an editorial published with the report.

Marsden said the findings should spur studies in North America and Europe to see whether long-term lead exposure in other parts of the world is related to kidney disease progression.

In the Taiwan study, led by Dr. Ja-Liang Lin of Chang Gung University in Taipei, 202 patients had their "total-body lead burden" measured after an infusion of EDTA, a substance that draws lead from body tissue.

After patients with high-normal levels were found to have greater disease progression over two years, 64 then entered a trial of chelation therapy--a tactic that has long been used to treat lead poisoning. During chelation, EDTA infusions were again used to pull lead from patients' body tissue so that it could be excreted.

Over the next two years, treatment improved patients' kidney function and staved off progression of the disease compared with those who received an inactive placebo treatment.

According to Lin's team, all of this suggests that chronic low-level lead exposure may "subtly influence" the progression of chronic kidney failure in patients without diabetes. None of the study patients had diabetes, a major cause of kidney failure.

Whether chelation will become a standard treatment for kidney-failure patients with high-normal lead levels remains to be seen, however.

Marsden pointed out that, right now, clinics are not routinely testing kidney-failure patients' body lead burden. He said that large multi-center studies into the issue are now needed.

Source: The New England Journal of Medicine 2003;348:277-286.

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Old Drug Still Best at Pregnancy Seizure Prevention

 

By Alison McCook

Reuters Health

Wednesday, January 22, 2003

NEW YORK (Reuters Health) - Women who develop high blood pressure during pregnancy--a potentially life-threatening complication--appear to benefit more from a commonly used treatment than another drug that dilates the blood vessels feeding the brain, according to new research released Wednesday.

Specifically, investigators found that women who took the anticonvulsant magnesium sulfate were one third as likely to experience seizures as women who received the drug nimodipine.

Just why dangerously high blood pressure in pregnancy, a condition known as preeclampsia, can cause seizures remains a mystery, and these findings may also help explain why one condition can lead to the other.

During the current study, reported in the January 23 issue of The New England Journal of Medicine (news - web sites), Dr. Michael A. Belfort of the University of Utah in Salt Lake City and his colleagues gave either the drug nimodipine or magnesium sulfate to 1,650 pregnant women.

These women had severe preeclampsia, and were at high risk for eclampsia, a potentially deadly condition in which a woman has seizures in late pregnancy or during the first week after delivery.

Belfort and his colleagues discovered that women who received nimodipine were three times as likely to develop seizures as women who took magnesium sulfate, although both groups were just as likely to deliver healthy babies.

Despite these findings and the fact that doctors have given magnesium sulfate to women with preeclampsia for decades, just how the drug prevents seizures remains unclear, Belfort told Reuters Health.

"It is an interesting paradox that the drug is in such widespread use and yet its mechanism of action is so poorly understood," he noted.

But the fact that magnesium sulfate works better than nimodipine adds pieces to the puzzle of how high blood pressure can lead to seizures in pregnancy, another mysterious process, Belfort noted.

Nimodipine works by opening up blood vessels that have gone into spasm, Belfort explained, a problem that he said he and his colleagues had suspected at the outset of the study may result in seizures among women with preeclampsia.

"Our study showed that this is not the case in most patients with eclampsia," he noted. This finding is "probably the most important aspect of the work, since it sheds likely on the pathophysiology of the disease itself and makes the study not a simple comparison of two drugs that do the same thing."

Based on his findings, Belfort proposed that seizures in preeclampsia may result from an oversupply of blood to the brain. Using nimodipine to open up blood vessels and increase blood supply even further just made the condition worse, he noted.

Belfort added that women with preeclampsia would most likely not benefit from nimodipine, but that the drug could still help women with eclampsia who appear to have blood vessels that are in spasm.

For most women with severe preeclampsia, magnesium sulfate is likely the best option, Belfort added.

In an accompanying editorial, Dr. Michael F. Greene of Massachusetts General Hospital in Boston notes that although experts remain unclear why magnesium sulfate works, it is nonetheless the best treatment doctors have to offer.

"At the beginning of the 21st century, the mechanism of action of the simple magnesium ion in preeclampsia and eclampsia eludes precise definition, yet magnesium remains the standard of care," he writes.

Source: The New England Journal of Medicine 2003;348:304-311,275-276.

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Jungle Remedy Eases Perils of Primate Pregnancy

 

Reuters

Wednesday, January 22, 2003

LONDON (Reuters) - Never underestimate the intelligence of primates.

In what scientists believe may be the first example of an animal taking a natural drug during pregnancy, researchers from Japan's Kyoto University have noticed that the sifaka, a type of lemur, eats plants containing poisonous tannins before giving birth.

Small amounts of tannins are known to stimulate milk production and veterinarians use them to prevent miscarriage.

"This makes them the first animal known to self-medicate when pregnant," according to New Scientist magazine.

Michael Huffman, a primate expert at the university, said pregnant females observed in Madagascar ate more tannin-rich plants than other males or females.

Although he can't be sure that the results are due to tannins and not other factors, primates have been spotted eating other natural medicinal products in the jungle.

"Some 39 species have been observed eating soil, which soaks up toxins in the gut and allows the animals to eat poisonous plants without getting sick," according to the magazine.

Chimpanzees also swallow leaves whole to induce diarrhea to get rid of tapeworms and other parasites.

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TUESDAY, JANUARY 21, 2003

Most Doctors Behind the Times 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 21, 2003

TUESDAY, Jan. 21 (HealthScoutNews) -- If it's time for your cat to get shots, your vet will probably send you a reminder in the mail, but new research suggests the same doesn't hold true for humans.

The study found many doctors don't routinely use computers to send medical reminders -- whether it be for mammograms or blood tests -- nor do they take advantage of many other programs that track patients between visits.

Doctors on average have adopted only about five of 16 recommended "care management" approaches. One in six doctors doesn't use any of the programs, which include such things as compiling lists of patients with similar diseases, educating the sick to help themselves, and offering ways for patients to grade their medical care.

"Medicine is still practiced like it was 90 or 100 years ago," says study author Dr. Lawrence Casalino, an assistant professor of health studies at the University of Chicago. "Medical care traditionally has been what your individual doctor can do in 10 to 15 minutes when you happen to show up at his or her office. If you don't come in, nothing happens."

Researchers at the University of Chicago and University of California at Berkeley interviewed top officials at 1,040 medical groups and independent practice associations from 2000-2001. The groups act as intermediaries between insurance companies and doctors.

The officials described how their doctors take care of patients with four chronic diseases -- asthma, congestive heart failure, depression and diabetes. The findings of the survey appear in the Jan. 22 issue of the Journal of the American Medical Association (news - web sites).

According to the survey, 70 percent of doctors don't keep registries of patients with chronic diseases. "If a medical group doesn't know who their diabetics (news - web sites) are, it's hard to know if they're getting their blood sugar checked at appropriate intervals and getting flu shots," Casalino says.

The survey also found half the doctors don't use computers to keep track of the medical needs of their patients.

Casalino acknowledges doctors are making progress, but he still finds it "a little odd" that veterinarians do a better job of tracking their patients between appointments than doctors do.

Why are doctors failing to adopt the recommended programs, which have been touted in federal reports? "There's a certain lack of awareness because these things aren't well known yet, and a lot of physicians are skeptical of them," Casalino says.

The medical profession is also behind most other industries in its adoption of medical technology, he adds, pointing out that many doctors still give drug orders by hand, potentially causing many more errors than by ordering them through a computer.

"The industry is behind, but doctors' offices are especially behind," he says. "They have the least capital to invest and the fewest managers around to make these things happen."

In California, change is coming courtesy of a coalition of insurance companies, medical groups, doctors, patients and others. The group, known as the Integrated Healthcare Association, is adopting a system that will provide extra funds for medical groups that adopt recommended approaches to taking care of patients, says executive director Beau Carter.

One problem is the current system doesn't reward groups of doctors "for being the best," Carter says. "We've got our work cut out for us."

More information

To find out more about health plan quality, visit the National Committee for Quality Assurance or the Institute for Healthcare Improvement. For more on the managed-care industry, try the American Association of Health Plans.

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Women Seen Undertreated for Heart Disease

 

By Michael Rubinkam

Associated Press Writer

The Associated Press

Tuesday, January 21, 2003

PHILADELPHIA - A new study adds to the evidence that many women who suffer heart attacks are not getting adequate treatment.

The study found that doctors often fail to prescribe aspirin, beta blockers and cholesterol-lowering drugs to these women, even though the medications have been shown to prevent further heart attacks or other heart trouble.

The researchers did not look at how often these drugs were offered to men. But other studies have shown that men and women alike are undertreated for heart disease, and women are treated even less aggressively than men.

"Doctors in our society just aren't good with prevention efforts," said study co-author Dr. Michael Shlipak of the University of California at San Francisco.

Shlipak said there could be a number of reasons for the findings. There is a lingering myth that heart disease is primarily a man's disease, he said. Moreover, both doctors and patients fear the side effects of some preventive drugs, he said.

The study, in Tuesday's Annals of Internal Medicine, involved 2,763 postmenopausal women with heart disease. All had suffered heart attacks or chest pain caused by blocked arteries, or had undergone bypass surgery or angioplasty.

Researchers found that beta blockers, which slow the heart rate, were used by only a third of the women who should have been taking them. Only half the women who qualified for cholesterol-lowering drugs took them.

Even aspirin was underused: Though all of the heart attack survivors in the study should have been taking it, only 80 percent did.

The research highlights "a terrible discrepancy between what we know and how we treat our sisters and mothers," Drs. Andrew Miller and Suzanne Oparil of the University of Alabama at Birmingham said in an accompanying editorial. "This report confirms previous evidence that women with (heart disease) are being undertreated in the United States."

Dr. Naveed Malik, a cardiologist at the Ochsner Clinic Foundation in New Orleans, said heart disease often goes undetected in women in the first place. For example, a woman complaining of chest pain might be diagnosed with heartburn.

"But similar symptoms in men might prompt (doctors) to think about coronary artery disease first," said Malik, who was not connected with the study.

Dr. Howard C. Herrmann, a cardiologist at the University of Pennsylvania Medical Center, said both men and women are being undertreated for heart disease.

"I think this should serve as a wake-up call to physicians and patients that they need to more aggressively use appropriate drugs like aspirin, beta blockers and ACE inhibitors in women with heart disease," he said.

The findings were extracted from a 1993-98 study of the effects of hormone supplements on the heart. That study was funded by Wyeth-Ayerst Laboratories, maker of the best-selling hormone brands. Last July, a landmark study declared that the increased risk of heart disease and breast cancer (news - web sites) from using hormones far outweighs any health benefits.

On the Net:

Annals of Internal Medicine: http://www.annals.org

American Heart Association (news - web sites): http://www.americanheart.org

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Too Much on Your Plate? U.S. Food Portions Balloon 

Reuters Health

Tuesday, January 21, 2003

NEW YORK (Reuters Health) - The super-sizing of the American waistline over the past 30 years has coincided with a sharp increase in food portion sizes inside and outside the home--most notably in fast food restaurants, according to a study released Tuesday.

The findings confirm suspicions that serving sizes have grown ever larger and may be contributing to the rising rates of overweight and obesity in the US. According to researchers, nearly one third of US adults was obese in 1999, up from about 15% in 1971.

But so far, no study has documented an actual increase in portion sizes, explain researchers in the January 22nd/29th issue of the Journal of the American Medical Association (news - web sites).

In the current study, they analyzed data from national surveys conducted between 1977 and 1998 and including more than 63,000 people aged 2 years and older. Portion sizes increased for nearly all foods at home and in restaurants.

The serving size of an average soft drink, for instance, increased from 13 ounces and 144 calories to nearly 20 fluid ounces and 193 calories. The average cheeseburger grew from 5.8 ounces to 7.3 ounces, swelling from 397 to 533 calories.

And salty snacks grew from 1 ounce to 1.6 ounces, climbing from 132 calories to 225 calories.

Pizza was the only food that didn't blossom in size or calories between the late 1970s and the mid-1990s, and portions actually decreased in size.

The largest portion sizes were found in fast food restaurants between 1994 and 1998, but for desserts, hamburgers, and cheeseburgers, the largest portion sizes were actually dished out at home.

Since an additional 100 calories a day can translate into 10 extra pounds a year, the study underscores the need to control portion size as a way to control weight.

"Simply educating the public about which foods to eat or not to eat is not enough, as an equally important issue is the quantity of food being consumed," Dr. Barry M. Popkin and Samara Joy Nielsen from the University of North Carolina at Chapel Hill, write.

They note that food pricing and marketing are potential barriers to changing behavior. Fast food restaurants, for instance, offer much larger portions for minor increases in prices. In some cases, it is less expensive to buy the larger portions.

Source: Journal of the American Medical Association 2003;289:450-453.

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Alzheimer's, Cholesterol Gene Linked

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, January 21, 2003

CHICAGO - A variation in a gene that is supposed to help the brain break down cholesterol may play a role in some cases of Alzheimer's disease (news - web sites), researchers say.

A study found that people with this variant form face double the risk of developing late-onset Alzheimer's, the most common form of the disease. It typically develops after age 65.

The gene, called CYP46, is involved in production of an enzyme that helps break down excess cholesterol in the brain. The research suggests that the variation might hamper production of the enzyme, resulting in a buildup in the brain of cholesterol and a gummy protein called beta amyloid.

The research, though preliminary, fits in with growing evidence that elevated cholesterol levels may raise the risk of Alzheimer's.

It also adds to evidence that genetics are involved. Late-onset Alzheimer's already has been linked to another genetic variation in a different gene involved in helping transport cholesterol throughout the body. That variation is called APOE-4.

In the new study, patients with both the CYP46 and APOE-4 variants were almost 10 times more likely to develop the mind-robbing disease than those with neither variation. They also had the highest brain levels of beta amyloid.

Autopsies also showed participants with just the CYP46 variant had significantly more beta amyloid deposits than those without the variant.

Dr. Andreas Papassotiropoulos at the University of Zurich and colleagues studied more than 400 European patients with or without Alzheimer's. The CYP46 variant was found in about 40 percent of participants.

The findings appear in January's Archives of Neurology.

Most of the estimated 4 million Americans with Alzheimer's have late-onset disease. It affects about one in 10 Americans over age 65 and nearly half of those over 85, according to the Alzheimer's Association.

An increasing number of studies suggest that cholesterol plays an important role in regulating beta amyloid.

Studies such as Papassotiropoulos' suggest that inhibiting cholesterol breakdown in the brain "might represent a viable treatment" for Alzheimer's, Dr. Benjamin Wolozin of Loyola University Medical Center in Maywood, Ill., said in an accompanying editorial.

On the Net:

Archives: http://archneurol.com

Alzheimer's Association: http://www.alz.org

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Italian Scientists Discover Migraine Gene

 

By Rachel Sanderson

Reuters Health

Tuesday, January 21, 2003

MILAN (Reuters) - Two Italian scientists have discovered a gene linked to severe migraines, a finding they say could pave the way to banishing not only migraines but everyday headaches as well.

Geneticist Giorgio Casari and neuroscientist Roberto Marconi of Milan's San Raffaele Institute spent four years screening the genetic makeup of six generations of a migraine-prone family and found they all had a gene in common.

"We have discovered a new gene related to migraines and this opens a pathway ... to new therapeutic approaches," Casari told Reuters from his Milan office Tuesday.

The research is set to be published online by journal Nature Genetics later Tuesday.

Found in chromosome 1--one of the most well-documented chromosomes of the human body--the ATP1A2 gene causes a malfunction of the pump that shifts sodium and potassium through the cell, the scientists said.

Rather than healthy, polygon-shaped cells, the mutant cells were rounded and swollen, leading to the pain, flashing lights and sensation of tingling hair that debilitates severe "aura" migraine sufferers.

"The chromosome is so well researched, it will not be difficult or take long to find a therapy for it," Casari said.

Current pills for headaches tend to numb the pain but not mend the cause, and targeting the faulty pump action could head off the pain at its source, helping not only sufferers of hard-hitting migraines but those who get common headaches too.

"A milder form of the mutation could be responsible for a milder headache," Marconi said.

Hundreds of trial patients are lined up to participate in the next round of research, which will look into whether the gene is also responsible for milder headaches, the scientists said.

Casari and Marconi are ready to work with drug developers to find a treatment to fix the faulty pump action. They say the right drug could already be available but existing treatments need to be tested for suitability.

The pair are the latest Italian scientists to carry out breakthrough research on a shoe-string budget, overcoming reams of red tape--a predicament that has caused many of Italy's best scientific minds to flee the country.

Casari said the research cost around $100,000, a trickle compared with the rivers of funds available to US and British scientists.

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Infants and Stroke: A Very Real Concern

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 21, 2003

TUESDAY, Jan. 21 (HealthScoutNews) -- When you think of childhood ailments, chicken pox and ear infections might come to mind.

Now you can add stroke to the list.

Neurologists say strokes are as common in newborns as they are in the elderly. In older children, strokes are far rarer, but they do occur.

Surprised?

You're not alone. Neurologists say many parents and even pediatricians are unaware of the risk of stroke in the very young. As a result, strokes in newborns and children are often missed, says Dr. Donna Ferriero, chief of neurology at the University of California, San Francisco.

Strokes are diagnosed late or not at all, little is known about how to prevent strokes, and there are few well-accepted treatments for strokes in the very young, she says.

"There are two peaks of incidence of stroke, in infancy and old age," Ferriero says. "Stroke in newborns is as big a problem as it is in the elderly. It's very, very common."

An analysis of a national hospital database found four in 1,000 newborns had a stroke. Newborn is defined as the period during gestation to 30 days old, Ferriero says.

Strokes in older children are much less common. About seven in 100,000 children had a stroke, according to the analysis, which was published recently in the journal Neurology.

Still, parents and physicians need to be aware strokes can occur.

The symptoms of stroke in children and adults are similar, says Dr. Deborah Hirtz, a pediatric neurologist and program director for the National Institute of Neurological Disorders and Stroke.

A child may suddenly start to favor one side of the body, or one hand. If a child does this from birth, it may indicate a stroke that was missed earlier, Hirtz says.

"When an adult has a sudden onset of difficulty forming words, a sudden onset of a weakness in an arm or leg or one side of the body, or sudden difficulty with balance and coordination, people tend to think of stroke," says Hirtz, who is chairwoman of child neurology at the American Academy of Neurology (news - web sites). "But when it happens to children, people don't think of stroke. They think it will go away. There's a much lower awareness that a stroke can happen to a child."

In infants, strokes are harder to spot because the very young lack muscle coordination anyway, Hirtz says. An MRI scan can reveal the damage to the brain and confirm a stroke.

"If a parent has a 5-month-old who's only using one hand to hold the bottle, there's a problem and they need to come in and have an MRI," Ferrerio says.

The causes of stroke in infancy and childhood are largely unknown. Research suggests many factors probably contribute, including infections, birth defects, blood-clotting disorders and birth trauma, Ferriero says.

Ferriero and her colleagues reviewed medical records of 30 pairs of mothers and babies who had a stroke. Researchers found 18 of the babies had risk factors that included blood-clotting disorders, problems during the pregnancy such as infections, fevers or a difficult birth.

Researchers were able to test the blood samples of seven of the babies who had strokes. Four had a genetic blood-clotting disorder.

"Our hypothesis is that multiple risk factors set a neonate up to have a stroke," Ferriero says.

Researchers hope that studying the causes of stroke in newborns may reveal clues about some of the genetic underpinnings of strokes in adults.

"We think that if we could figure out the risk factors for stroke in the newborn, we could help adults," Ferriero says.

What is known is that strokes can be devastating at any age. Strokes in infants are a common cause of cerebral palsy, a neurological disease that's marked by severe abnormalities in movement and muscle weakness.

And children who've had a stroke are susceptible to having another one. About 6 percent of children who have a stroke die, about 25 percent of children have another stroke and about two-thirds have lasting neurological problems or seizures, according to the study.

The good news is that children's brains are very "plastic," meaning they have a great capacity to learn to compensate for the damage.

That's why it's so critical to diagnose the stroke early. The sooner children begin physical, occupational or speech therapy, the better the chance they have at adapting, Ferriero says.

More information

To read more about childhood stroke, visit the Pediatric Stroke Network, the Children's Hemiplegia and Stroke Association, or the National Institute of Neurological Disorders and Stroke.

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Docs' Independence Key to Job Happiness, Not Pay

 

By Anthony J. Brown, MD

Reuters Health

Tuesday, January 21, 2003

NEW YORK (Reuters Health) - Findings from a recent survey of primary care and specialist physicians in the US indicate that autonomy in making clinical decisions is the primary factor that determines career satisfaction, not income.

"Mild career dissatisfaction among physicians may not be particularly concerning," lead author Dr. Bruce E. Landon from Harvard Medical School (news - web sites) in Boston told Reuters Health. "However, if such dissatisfaction causes physicians to leave their practice or affects the care of patients then it can be quite important."

The current findings are based on a survey of more than 12,000 physicians at 60 US sites who were interviewed about career satisfaction in 1997, 1999 and 2001. The report is published in the January 22/29th issue of the Journal of the American Medical Association (news - web sites).

During the study period, a slight decrease in physician satisfaction levels was noted. For example, about 42% of primary care physicians and 43% of specialists were "very satisfied" in 1997, compared with 39% and 41%, respectively, in 2001.

The researchers found that the geographic location of the physician practice and the survey year played an important role in determining satisfaction. Of the 12 locations evaluated, Lansing, Michigan in 1999 had the lowest rate of physician dissatisfaction--9%. In contrast, Miami in 1997 had the highest rate of dissatisfaction--34%.

Between 1997 and 1999, the percentage of physicians who reported decreased satisfaction exceeded the percentage who reported improved satisfaction. From 1999 to 2001, however, these percentages were roughly equal.

In analyzing the findings, the researchers found that measures of clinical autonomy, such as the number of work hours and the ability to order services for a patient, were the strongest predictors of career satisfaction.

"Overall, there was little change in physician satisfaction during the study period," Landon noted. "But, when you look at the overall picture, it really masks what is going on in individual markets. Some markets, like Lansing, had very low rates of dissatisfaction, while others, like Miami, had much higher rates.

"We found that clinical autonomy was much more important than physician income at predicting satisfaction," Landon said. The degree of autonomy may explain why some markets are associated with higher satisfaction rates than others, he noted.

Landon said that his team will conduct a similar survey in 2003-2004. In addition, his team plans to reanalyze the current data to identify factors that predict whether a physician will cut back on work hours or actually leave the field.

Source: Journal of the American Medical Association 2003;289:442-449.

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Fiber Feast

HealthScoutNews

Tuesday, January 21, 2003

(HealthScoutNews) -- Many doctors push fiber as an essential part of a patient's diet. Because it retains water, fiber helps food pass through your digestive system faster, causing a laxative effect. It can also help lower your cholesterol.

But how much fiber is enough? The American Dietetic Association recommends between 20 and 35 grams a day. Generally, if a product contains 3 grams of fiber per 100-gram serving, it's a good source. Some fiber-rich foods include flaxseed, fruit, oats, barley and beans.

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Time of Day Affects Drug's Blood Pressure Control

 

By Keith Mulvihill

Reuters Health

Tuesday, January 21, 2003

NEW YORK (Reuters Health) - Several different classes of drugs can be used to get blood pressure under control, and now a small study suggests that some may be more effective at certain times of the day than others.

"Different classes of drugs act more effectively at different times of the day," Dr. Trefor O. Morgan told Reuters Health. "This differential effect has not previously been clearly shown."

The new findings suggest that prescribing more than one blood pressure medication may provide more effective treatment, according to Morgan, of the University of Melbourne in Australia.

Normally, a person's blood pressure dips and climbs over a 24-hour period. Blood pressure climbs most rapidly in the morning after awakening and typically plateaus during the middle-to-late portion of the day. It then declines in the evening and is lowest during sleep.

In the current investigation, Morgan and co-author Adrianne Anderson looked at the effects of four different blood pressure medications on 24 people over age 65 with elevated systolic blood pressure--the first number in a blood pressure reading.

Each of the patients took one medication or a placebo for two months before switching to the next treatment. Blood pressure measurements were taken three times over a 24-hour period at the end of each of five treatment periods.

The medications evaluated include a diuretic (hydrochlorothiazide), a beta-blocker (atenolol), an angiotensin converting enzyme (ACE) inhibitor (perindopril), and a calcium channel blocker (felodipine).

Their results are published in the January issue of the American Journal of Hypertension.

The investigation found that diuretics and calcium channel blockers were relatively consistent at lowering blood pressure around the clock, said Morgan. Beta-blockers, on the other hand, lowered daytime blood pressure but had little effect on nighttime blood pressure. ACE inhibitors lowered blood pressure more at night than during the day, Morgan noted.

"Experiments in animals and human observations indicate that nighttime blood pressure elevation is associated with more cardiac enlargement and a higher morbidity and mortality," Morgan told Reuters Health.

As a result, combinations of drugs may need to be used to obtain optimal blood pressure control over a 24-hour interval, according to Morgan.

"The reason that beta blockers may not have as good results as diuretics on complications may result from (its) failure of blood pressure control at night," Morgan added.

Currently, the majority of patients with hypertension are on one drug, Morgan said. However, single drug therapy controls blood pressure in less than 30% of patients, according to the Australian researcher.

"This may explain why control of blood pressure achieved in the community is so poor," he concluded.

In conclusion, blood pressure is controlled by a large number of variables.

We recognize this by the individual variation that occurs in response to specific drugs.

The evidence from this study those different times of the day may require us to rethink our therapeutic strategies.

It is probably an additional reason to use multiple drugs rather than relying on high dose monotherapy.

Source: American Journal of Hypertension 2003;16:46-50.

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Thalidomide Proving Its Mettle as Cancer Fighter

HealthScoutNews

Tuesday, January 21, 2003

TUESDAY, Jan. 21 (HealthScoutNews) -- Thalidomide may help people with bone marrow cancer live longer.

The latest finding, from a Mayo Clinic study in the January issue of the Mayo Clinic Proceedings, adds to a growing body of evidence that suggests the drug may be a powerful cancer treatment.

The study included 32 people with advanced multiple myeloma whose treatments with standard chemotherapy or stem cell transplantation failed. Almost a third of those in the study responded to thalidomide for an average of about a year.

This study confirms findings from an earlier study from the University of Arkansas.

Multiple myeloma is an incurable cancer of the bone marrow. About 14,600 people in the United States were diagnosed with myeloma in 2002, and about 10,800 people died from myeloma. The average survival time from diagnosis is three to four years for people treated with conventional chemotherapy.

Thalidomide is not approved by the U.S. Food and Drug Administration (news - web sites) for the treatment of myeloma.

More information

Here's where you can learn more about multiple myeloma.

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Doctors Lack Incentives for Improving Patient Care

 

By Karen Pallarito

Reuters Health

Tuesday, January 21, 2003

NEW YORK (Reuters Health) - Doctors do a whole lot more to improve patient care when they are rewarded for quality, but they rarely receive such incentives, according to a study in the January 22/29 issue of the Journal of the American Medical Association (news - web sites).

This is the first national study to demonstrate a connection between quality-of-care incentives and physicians' use of so-called "care management processes," lead author Dr. Lawrence Casalino of the Department of Health Studies at University of Chicago, and colleagues point out.

Some incentives work better than others. Groups of doctors who receive public recognition and better contracts for providing quality care, for example, were more likely to have those systems of care in place. Having the appropriate clinical information systems also helps, the researchers found.

Yet one third of the 1,040 medical groups and independent practice associations surveyed had no outside incentive to improve quality, the study found.

Recent reports from the Institute of Medicine (news - web sites) and elsewhere suggest poor quality is largely due to faulty systems of care, not incompetent physicians or a lack of effective treatments--a conclusion bolstered by the new study.

"There are means available to improve the quality of care for people with chronic diseases ...but for the most part, the groups aren't using them," Casalino told Reuters Health.

Casalino and his colleagues at the University of California's Berkeley and San Francisco campuses examined a total of 16 processes for managing patients with asthma, congestive heart failure, depression and diabetes. They assessed whether doctor groups use case management and disease registries, for example, and whether they provide feedback to physicians on their care management practices.

Half of the physician organizations in the study used no more than four of the 16 processes surveyed. Nearly one in six used none.

Some health plans and purchasers have begun to experiment with incentives for improving quality, including "pay for performance" arrangements that reward physicians financially for scoring well on measures of clinical quality.

Casalino applauds such experiments, even though receiving a bonus for good quality did not significantly boost the use of care management techniques by physicians in the study.

"As far as we can tell...it is because the amounts given have been very small. And usually the medical groups will tell you that they need to have enough money involved to make it worth their while," he told Reuters Health.

The biggest obstacle, he added, is the up-front investment needed to put these organized processes of care in action. That's money the groups aren't getting back.

Doctors typically get paid to diagnose and treat, not to manage the care of chronically ill patients, said Warren Todd, executive director of the Disease Management Association of America. Disease management companies, by contrast, bet that the extra services they provide will save money for a health plan or sponsor.

"We've made not as much progress as anyone would like in bringing the physicians into that loop," Todd said. His group is trying to change that by working with the American Medical Association, the American College of Cardiology and others to get physicians up to speed.

Government and private purchasers of care can help by giving doctors incentives to improve quality and develop clinical information systems, Casalino's team concludes.

"If insurers and public payers...develop financial incentives for medical groups to invest in information technology and then infrastructure for care management, it will greatly improve the quality and safety of patient care," said Dr. William Jessee, president and CEO of the Medical Group Management Association. "But if payers continue to reduce their payments to physicians, it seems likely that little improvement will occur."

Source: Journal of the American Medical Association 2003;289:434-441.

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Gene Therapy Helps Poor Circulation in Legs

HealthScoutNews

Tuesday, January 21, 2003

TUESDAY, Jan. 21 (HealthScoutNews) -- Gene therapy that stimulates the growth of new blood vessels may someday replace the need for amputation in people with severe circulation problems in their legs.

Researchers from the Jobst Vascular Center in Ohio presented their findings Jan. 21 at the 15th Annual International Symposium on Endovascular Therapy in Miami Beach. They conducted a Phase I trial to assess a genetically engineered angiogenic growth factor called NV1FGF in legs with severely blocked blood vessels.

The study of 51 patients found the treatment was safe and the procedure showed some evidence -- less pain, improved ulcer healing and enhanced blood pressure -- of improved circulation in the legs.

The researchers are now enrolling 70 people in a Phase II trial that will compare the effectiveness of the growth factor against a placebo.

Diabetes, smoking, high cholesterol levels and genetics can cause people to develop blocked arteries in the legs. In most of those people, bypass surgery or angioplasty can restore circulation. However, some people with blocked arteries in the legs don't respond to standard treatments and have a poor prognosis.

As many as 40 percent of those people must have leg amputation, and one in five dies within six months, the researchers say.

More information

Here's where you can learn more about atherosclerosis in the legs.

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MONDAY, JANUARY 20, 2003

Macho Shoveler  

HealthScoutNews

Monday, January 20, 2003

(HealthScoutNews) -- Snow shoveling often is a riskier activity for men than women, says the Harvard Medical School (news - web sites) advisor. Some men see snow shoveling as a challenge and will keep at it until every last flake is out of the way. Women, on the other hand, will usually clear a narrow path that's safe enough to pass through.

As a rule, men with heart disease shouldn't shovel snow. And even healthy men over age 50 should avoid it. Some older men have heart disease without knowing it.

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Repeat Colorectal Exam Likely if Sedated First Time

 

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - While most people aren't eager to have a colorectal exam, a new study has found that those who underwent a colonoscopy with sedation had less discomfort and were more willing to undergo the procedure a second time compared to those who got a sigmoidoscopy without sedation.

In flexible sigmoidoscopy, a lighted tube is inserted into the rectum to view the lower portion of the colon and check for any polyps, or small growths, that can develop into cancer. A colonoscopy is similar, but allows the entire colon to be examined. Colonoscopy requires a patient to be sedated and is more expensive.

Cancer of the colon or rectum is the fourth most common cancer among both men and women in the US. In 2002, almost 150,000 Americans were diagnosed with the disease and approximately 56,000 will likely die as a consequence.

Colorectal cancer screening methods include fecal occult blood testing to identify blood in the stool, colonoscopy and sigmoidoscopy. CDC guidelines suggest everyone over 50 have a fecal occult blood test once a year, a colonoscopy once every five years and a full x-ray of the colon every 10 years.

"A major concern of patients undergoing endoscopic procedures is the fear of pain and discomfort experienced during the procedure, and this concern is a major reason for non-adherence to screening protocols," write Dr. R. Zubarik and colleagues from the University of Vermont.

In the current study, the authors compared the experiences of 243 people who underwent colonoscopy with sedation to 162 people who had a sigmoidoscopy without sedation. They report their findings in the December issue of The American Journal of Gastroenterology.

During a telephone interview about two weeks after the procedure, 28% and 14% of those who had the colonoscopy with sedation reported discomfort during the procedure and after the procedure, respectively.

Of those who had sigmoidoscopy, 58% reported that they had discomfort during the exam and 16% reported discomfort after the exam.

What's more, men and women who underwent the colonoscopy with sedation were more willing to undergo the procedure again compared to those who had sigmoidoscopy, the study indicates.

"In this study, we demonstrated that screening colonoscopy preformed with sedation is associated with less abdominal discomfort than screening flexible sigmoidoscopy," write the authors.

"Patients were also significantly more willing to undergo subsequent screening colonoscopy than screening sigmoidoscopy," they add.

Nonetheless, Zubarik and colleagues note that their study "did not definitively demonstrate that procedural discomfort was the cause of refusal to undergo subsequent screening examinations." But there is evidence that this is the case, they note, such as the fact that patients who didn't wish to have the exam again were more likely to have discomfort, and tended to have more severe discomfort.

Source: The American Journal of Gastroenterology 2002;97:3056-3061.

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Cataracts

HealthScoutNews

Monday, January 20, 2003

(HealthScoutNews) -- Dark-eyed people are more prone to cataracts than individuals with light eyes.

Researchers at the University of Sydney, Australia, studied the eyes of 3,600 men over a 5-year period and found the people with dark brown eyes had an 80 percent greater chance of developing cataracts.

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Hurt Kids More Resilient Than Adults with Injury

 

By Alison McCook

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - People under the age of 16 are less likely to suffer multiple organ failure after injuries than older people with equally severe injuries, new study findings demonstrate.

And when children and young teens do have failure of many organs at once, their risk of dying is much lower than that seen in adults with multiple organ failure, the researchers note.

"Clearly, we've shown that post-injury multiple organ failure occurs rarely in children given similar severity of injury, yet the reasons why remain unclear," lead author Dr. Casey M. Calkins of the University of Colorado Health Sciences Center in Denver told Reuters Health.

Understanding more about what protects children from multiple organ failure may yield new information about how to prevent and treat it when it occurs in people of all ages, Calkins added.

"If we can modify an adult's response to match that of a child following trauma, perhaps we can alter the incidence of multiple organ failure in the adult population," the researcher said.

Multiple organ failure occurs when more than one of the body's organs--such as the lungs, kidneys, liver or heart--fail to work properly. Researchers have long known that adults who survive a severe injury are at risk of experiencing multiple organ failure soon after, and estimates of the incidence of multiple organ failure in injured patients range from 13% to 26%.

In some hospitals, up to one third of injured adults with multiple organ failure die as a result, according to the researchers.

Calkins explained that people who suffer serious injuries can develop multiple organ failure as a result of damage caused by a dangerous boost in immune system activity following the injury, or from an infection that appears once the immune system overactivity subsides.

Experts have suggested that children might be less likely to show signs of multiple organ failure after severe injury. In order to determine whether or not this is true, Calkins and colleagues reviewed three years' worth of cases involving patients less than 16 years old who survived for at least 24 hours after a severe injury.

The authors base their findings on the medical records of 534 patients, 63% of whom had experienced head injury only. Most of the injuries were a result of motor vehicle accidents, bicycle accidents or sports.

Reporting in a recent issue of the Journal of Trauma: Injury, Infection, and Critical Care, Calkins and colleagues note that none of the patients who only had head trauma developed multiple organ failure. Among the 200 others with other injuries as well, six showed signs of multiple organ failure.

Among children and young teens with injuries other than head trauma, only 3% developed multiple organ failure, the authors note. Among those with multiple organ failure, only 17% died.

These rates are much lower than those seen in adults with equally severe injuries, the researchers report.

It is unclear why children should be somewhat protected from multiple organ failure, Calkins and colleagues write. They suggest that people of different ages may have different immune responses to injury, and changes in hormone levels after puberty may also boost the risk of organ failure after injury.

Source: The Journal of Trauma: Injury, Infection, and Critical Care 2002;53:1058-1063.

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Genetic Link to SIDS Found 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- A new study bolsters a suspicion long held by scientists that sudden infant death syndrome (SIDS) has a genetic component.

Reporting in the American Journal of Medical Genetics, the researchers from Rush University explain that they found infants who died of SIDS were more likely to have a particular mutation in the 5-HTT gene. That gene regulates serotonin, one of the brain's chemical messengers that helps regulate breathing and heart rate.

"We pursued [this line of research] because we had too many parents coming to us saying they had done everything they had been told to do and their babies still died," says study author Dr. Deborah Weese-Mayer, a professor of pediatrics at Rush University and director of respiratory medicine at Rush Presbyterian St. Luke's Medical Center, both in Chicago.

Years of public education encouraging parents to stop smoking around their infants and to have babies sleeping on their backs has helped dramatically lower the rate of SIDS in the United States. Despite that decrease, 2,500 babies still die every year from this puzzling disorder, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Last year, a study published in Pediatrics reported that Japanese babies who died of SIDS were more likely to have an L allele in the 5-HTT gene than healthy babies. An allele is a mutation in the gene that can change physical characteristics.

Building on that research, Weese-Mayer and her colleagues collected DNA samples from 87 U.S. infants who died of SIDS and compared them to two sets of healthy infants. The first infant control group was matched as closely as possible to the gender and ethnicity of the SIDS babies. The second control group was a random group of 334 infants that the researchers used to determine the frequency of each allele in the general population.

As in Japan, the U.S. researchers found babies who died from SIDS were more likely to have the L allele in the 5-HTT gene than babies who survived. However, not every baby who had the L allele died from SIDS. Likewise, not all of the babies who died from SIDS had the L allele. The researchers also found healthy babies were more likely to have an S allele in the 5-HTT gene than babies who died of SIDS.

Weese-Mayer says the researchers were also able to pinpoint ethnic differences in this gene. Black babies were more likely to have the L allele than white babies were, which is important because black babies have a much higher rate of SIDS.

While this means the researchers have shown there can be a genetic underpinning to SIDS, there is still much research that needs to be done before a screening test to identify high-risk babies can be developed.

"This is a hypothesis we've been testing, and it's exciting to have it suddenly appear, but it's not a magic bullet," Weese-Mayer says. "There are other genes we're looking at, and I think the profile we're looking for will be a composite of genes."

She's also quick to point out that modifying the environmental factors will always be an important part of keeping the incidence of SIDS down. "Smoking is huge! Avoid cigarette smoking, both [prenatal] and postnatal. And that advice isn't just for mom. No one should smoke around pregnant women or babies," Weese-Mayer says.

Dr. Susanna McColley, acting division head of pediatric pulmonary medicine at Children's Memorial Hospital in Chicago, says it's important that people realize the researchers haven't found the SIDS gene. "You would find a lot of healthy kids with this allele," she says.

While she says this research needs to be validated in further studies, she says it "may allow us to see which kids will remain at high risk even when environmental risk is reduced."

More information

For information on lowering your child's risk of SIDS, visit the American SIDS Institute or the SIDS Alliance.

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Dangerous Gas May Improve Angioplasty Results

 

By Merritt McKinney

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Breathing in too much carbon monoxide can be deadly, but preliminary research suggests that the colorless, odorless gas holds promise as a way to keep unclogged arteries from becoming blocked again.

When rats were given a low dose of carbon monoxide before undergoing the artery-clearing procedure angioplasty, arteries were much less likely to re-clog afterwards.

It is too soon to say whether carbon monoxide will ever be used to prepare people for angioplasty, but researchers are now studying its effects in pigs, who have more human-like vessels than rats.

When an artery that delivers blood to the heart becomes blocked or narrowed, which can lead to a heart attack, angioplasty is one way to restore normal blood flow. During this treatment, a balloon-tipped catheter is threaded into a blocked artery and inflated, flattening fatty plaques against the artery wall. Eventually, however, more than half of cleared arteries become narrowed or block again.

When rats inhaled a low dose of carbon monoxide for an hour before angioplasty, re-clogging was "significantly inhibited," Dr. Augustine M.K. Choi, of the University of Pittsburgh in Pennsylvania, told Reuters Health in an interview.

Choi and his co-authors, including Dr. Fritz H. Bach at Harvard Medical School (news - web sites) in Boston, Massachusetts, released the findings Sunday in the advance online edition of the journal Nature Medicine.

In the interview, Choi explained that carbon monoxide may work in a couple of ways to keep arteries clear after angioplasty.

The Pennsylvania researcher said that after angioplasty, smooth muscle cells migrate to the site of the angioplasty. The proliferation of these cells can cause an artery to close up again. In the present study, Choi and his colleagues detected signs that carbon monoxide blocked the proliferation of these smooth muscle cells.

Another way that the gas may keep arteries clear, Choi said, is by fighting inflammation, which can contribute to re-clogging. Although the researchers did not look at that effect of carbon monoxide in this study, Choi said that previous research has shown that the gas can counteract inflammation.

The idea of inhaling carbon monoxide before having angioplasty may sound risky, but Choi emphasized that the amount used in the study is much less than that which can be harmful.

Source: Nature Medicine 2003;10.1038/nm817.

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The Smell of Strong Emotions

HealthScoutNews

Monday, January 20, 2003

 

MONDAY, Jan. 20 (HealthScoutNews) -- Reveling in the fragrance of a beautiful flower and being miserable as you endure the stench of changing the kitty litter may seem like opposite emotional experiences.

However, a study in the February issue of Nature Neuroscience says your brain's response to such strong pleasant and unpleasant emotions are actually quite similar.

The researchers had study subjects smell pleasant and unpleasant odors at different concentrations. Using brain imaging to observe the subjects' brain reactions, the researchers discovered that a key area for brain emotion -- the amygdala -- responded equally to both the pleasant and unpleasant odors, solely on the basis of their emotional intensity.

The amygdala has been regarded as an area that responds mainly to negative emotions. However, this study suggests that may be partly an illusion, caused by the correlation between unpleasantness and arousal.

More information

Here's where you can learn more about the workings of your nose.

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Fat Intake Not Linked to Dementia Risk: Study

 

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Despite some hints that fat intake may affect the risk of dementia, a new study has failed to show a link between fats--both the "good" and "bad" types--and mental decline.

But the Dutch study is not the final word on the subject, its authors say.

It would be "premature" to conclude that cholesterol and fats that affect cholesterol are not related to the risk of dementia, according to a team led by Dr. M.M.B. Breteler at the Erasmus Medical Center in Rotterdam.

Several pieces of evidence suggest that fat and cholesterol may influence the risk of Alzheimer's disease (news - web sites) and other forms of dementia.

For example, animal studies have shown that a high-cholesterol diet increases the build-up of Alzheimer's-related brain proteins. In addition, some evidence suggests that cholesterol-lowering medications, including widely prescribed drugs called statins, may reduce the risk of Alzheimer's.

Also, a type of polyunsaturated fatty acid (PUFA) has been shown to battle inflammation. Since inflammation may increase the risk of dementia, these fatty acids, which are found in fish and fish oils, could conceivably cut dementia risk.

Despite these suggestions of a relationship, the current study of more than 5,000 people published in the journal Neurology did not find a link between fat intake and dementia risk.

In the six-year study, which followed elderly participants who did not have dementia, people who ate high levels of total fat, saturated fat, trans fat and cholesterol were not more likely to develop dementia than people who ate less fat. Similarly, people who ate low levels of the type of fatty acids found in fish were not more likely to develop Alzheimer's disease or other types of dementia.

Source: Neurology 2003;59:1915-1921.

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New Heart Therapy May Spare Surgery

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- A new procedure that could bring the benefits of heart valve replacement to the oldest of the old and the sickest of the sick will soon be tested in trials in Europe and the United States, cardiologists say.

Problems with the two heart valves -- the mitral valve that controls the flow of blood between the two left chambers of the heart and the aortic valve that controls the flow of blood into the heart -- are common among old people, and so is surgery to replace a damaged valve with an artificial one.

Most commonly, surgeons saw open the breast bone to get at the heart and do the replacement. Some centers perform what is called minimally invasive surgery, which requires just a four-inch incision. However, many people with valve problems are too sick or too old to withstand the rigors of an operation. The new procedure, which eliminates surgery, is designed for them.

"This procedure is early-stage technology, but it has a lot of potential for the future," says a statement by Dr. Martin Leon, director of the Cardiovascular Research Center at Lenox Hill Hospital in New York City, who described the technique Jan. 20 at the 15th Annual International Symposium on Endovascular Therapy in Miami Beach, Fla. "If in the future we can demonstrate that these valves are durable, that we can do the procedure repeatedly, reliably and safely, it may in fact be competitive with surgical valve replacement in many circumstances."

The procedure uses a new type of replacement valve specially designed for the purpose. It is placed at the end of a flexible catheter that is inserted in the femoral vein in the groin and is guided to the diseased valve. It is put in place by inflating a balloon at the end of the catheter.

The procedure has been done just once, Leon told the meeting, on a 57-year-old Frenchman with a badly damaged aortic valve and other medical problems that made surgery impossible. After the procedure, done at the Hopital Charles Nicolle in Rouen, the man's condition improved considerably, and he was able to resume some normal activities. However, he died four months later of complications that were not related to the procedure or to his heart condition.

Clinical trials of the procedure will begin in the next few months in Europe and later this year in the United States, Leon says.

A formal trial aimed at getting U.S. Food and Drug Administration (news - web sites) approval of the technique probably will begin at the end of the third quarter of this year and will be conducted at several medical centers, he says.

Meanwhile, Dr. William O'Neill of William Beaufort Hospital in Royal Oak, Mich., will perform the technique on a "compassionate use" basis for selected patients, Leon says. It will be done "on patients who have no other alternative " and "are desperate," he says.

Such a procedure is badly needed, says Dr. Barry T. Katzen, medical director of the Miami Cardiac and Vascular Institute and chairman of the symposium, because "patients are living longer because of improvements in medical techniques and we are seeing more and more heart disease, including valve conditions. As the population ages, we are seeing these problems with increasing frequency."

This is "very early-stage research," Katzen cautions, and at best it will not be widely available for three to five years. But "this technology has great promise and it opens an area that is entirely new," he says.

The procedure can be used to replace either the mitral or the aortic valve, Katzen says, but now efforts are concentrating primarily on aortic valve replacement.

If it succeeds, it will not replace conventional surgery, Katzen says: "It is a procedure to be used only in patients who have no alternative and would die if it is not done."

More information

You can learn about heart valves, their problems, and repairs, from the American Heart Association or the Society of Thoracic Surgeons.

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Giving Blood May Aggravate Restless Legs Syndrome

 

By Merritt McKinney

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Donating blood on a regular basis may lead to iron deficiency in people with restless leg syndrome, according to a new study.

The results should not discourage people from donating blood, but it may be a good idea for people with the condition to have their iron checked before they roll up their sleeves, according to the study's lead author.

"Blood donation is important and this should not stop regular blood donors from donating if they do not suffer from restless legs," Dr. Michael H. Silber told Reuters Health.

However, people with restless legs syndrome who regularly donate blood should consider having their iron stores measured, according to Silber, who is at the Mayo Clinic in Rochester, Minnesota.

"If it is normal, no problem, but if it is low, then they should ask their physician about taking iron until it is normal and not donate until then," Silber said.

People with restless legs syndrome experience uncomfortable sensations and an urge to move their legs, most often at night. The syndrome, which affects about 10% of the US population, often runs in families.

Restless legs syndrome tends to worsen as levels of iron in the body drop. Silber and his colleagues began to study the connection between donating blood and restless legs syndrome when they saw a newly diagnosed patient who had iron deficiency. This person frequently donated blood, which can deplete iron levels.

Out of the next 245 patients seen for restless legs syndrome, eight regularly donated blood, on average about four times a year, and had iron deficiency. Four of the patients had mild anemia.

In three of the people, symptoms of restless legs syndrome started around the same time they started giving blood, and they began afterwards in another three study participants. In two people, symptoms of the condition began before they started donating blood.

A report on the study appears in the January issue of the journal Mayo Clinic Proceedings.

After treatment with iron, either alone or in combination with drugs used to treat restless legs syndrome, iron levels returned to normal in most people. Symptoms disappeared or improved considerably in everyone.

Silber and his colleagues do not think that blood donation was solely to blame for restless legs syndrome in these patients. They do, however, believe that giving blood played an "important role" in the condition.

The investigators recommend that doctors who treat people with restless legs syndrome ask their patients if they give blood. They also advise blood centers to ask blood donors about restless legs syndrome. Potential blood donors who have the condition should have their blood levels of ferritin--a marker for iron levels--tested, according to the report. If levels are low, they should take iron supplements to restore normal levels of iron, Silber and his colleagues recommend.

Source: Mayo Clinic Proceedings 2003;78:52-54.

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Mapping Melanoma's Spread

 

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- People with melanomas on their face and neck might find out earlier whether the deadly cancer has spread, thanks to new research highlighting the safety and effectiveness of a special kind of skin mapping in this sensitive area.

They may also receive treatment faster if the mapping shows the disease has spread to the lymph nodes, notes one of the authors of the largest such study to date.

Once diagnosed by their doctor as having melanoma, "these people have no idea if it's reached beyond the initial site," says Dr. Carol Bradford, director of the University of Michigan's Head and Neck Oncology Program. "Early detection is crucial."

Bradford and her colleagues performed the delicate procedure on 80 patients diagnosed as having head and neck melanomas. While sentinel lymph node mapping (SLNM) is commonly used to detect the spread of melanoma in other places where this cancer is found, it's not routinely done on patients with head and neck melanomas because there are so many facial nerves, muscles and blood vessels in this area, Bradford says. "They're crucial to preserve," so the surgeon must be very familiar with face and neck surgery to perform SLNM, she explains.

Once a person has been diagnosed with a mole that is a melanoma, he is then referred to a specialist to investigate whether the cancer is spreading.

Aside from feeling a lump in the lymph nodes signaling that the cancer has spread, it's not possible to know if the cancer has spread without surgery, Bradford says. To date, many patients with melanoma go on to have surgical removal of areas around the mole, which may not be necessary if the cancer has not spread.

With SLNM, radioactive material is injected around the biopsy site. Using a probe that is "like a metal detector," doctors find areas that have trapped the radioactive material and mark them as places to make an incision. In the operating room, the patient is injected with blue dye. "Hot areas" -- those lymph nodes signaling as radioactive and blue -- are then removed and sent to pathology labs to determine if they are cancerous. In this study, the researchers were able to identify a range of hot areas, from none to seven, in each patient.

"Sentinel" in SLNM refers to draining lymph nodes, and they are usually the first areas where cancerous cells would go, Bradford explains.

In the study, cancer was "found to be present in lymph nodes 18 percent of the time."

However, four out of five patients did not have cancer that had spread, she says.

Patients were followed for a minimum of a year, although median follow-up was 25 months. A false-negative rate (people who were determined to have no cancer in their lymph nodes but who later found the cancer had spread) was 4.5 percent.

"We'd love it to be zero," Bradford acknowledges, but the procedure is "technically challenging" and makes errors more possible.

This study, which appears in the Jan. 20 issue of the Archives of Otolaryngology, may prompt other surgeons to perform more SLNMs in the face and neck area, Bradford hopes. None of the patients suffered facial paralysis or any other devastating effect from the procedure. "It's safe to biopsy around this area where the facial nerve resides," Bradford says.

The study suggests that SLNM "is pretty reliable," notes Dr. William Silver, vice president of the American Academy of Facial Plastic and Reconstructive Surgery. "The majority (of patients) were negative. The more of these we do and follow to develop more information, the more we avoid unnecessary surgery."

Silver adds he would like to see longer follow-up on the patients, because the third or fourth year after the melanoma is first identified seems to be key in determining whether the cancer has been eradicated.

Dr. James Hartman, an assistant professor of otolaryngology at the Barnes-Jewish Hospital in St. Louis, performs SLNM and considers it "a valid tool." The researchers looked at using a "pretty well-established technique for other parts of the body in our region, the head and neck," he says.

Because 75 percent of all melanomas are in the head and neck area, many patients stand to benefit from the use of SLNM in this region, Silver says.

More information

For more on melanoma, go to the Melanoma Patients' Information Page. Check out sentinel lymph node biopsy at the National Cancer Institute.

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Gene Linked to Alcohol Risk in Pregnancy

 

By Merritt McKinney

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Some children are at greater risk than others for fetal alcohol syndrome if their mothers drink during pregnancy, and now a new genetic study provides one possible reason why.

The study found that women with a certain form of an alcohol-processing gene were much more likely to give birth to a child with signs of fetal alcohol syndrome.

"Women with an alternate form of one of the genes responsible for alcohol metabolism, the ADH2-1/3 form, can metabolize more alcohol," the lead author of the study, Dr. Joan M. Stoler, told Reuters Health.

It is possible, Stoler said, that women with this form of the gene may be able to drink more, which could expose the fetus to higher levels of alcohol than women with another form of the gene.

"These findings give us one potential reason for why some women who drink heavily have babies which have more fetal effects than others who drink the same amount," said Stoler, who is at Massachusetts General Hospital in Boston.

A report on the study was published in a recent issue of the Journal of Pediatrics.

Women who are pregnant or who are trying to conceive are discouraged from drinking because alcohol use during pregnancy can cause birth defects, including fetal alcohol syndrome, which is the leading non-genetic cause of mental retardation.

Although all women are recommended to abstain from alcohol when they are expecting, not everyone who abuses alcohol during pregnancy gives birth to a child with severe damage. Genes involved in processing alcohol are suspected of influencing the effects of drinking during pregnancy, but the evidence is mixed.

Stoler's team studied 404 women who were considered at high risk of drinking during pregnancy to see which version of the ADH2 gene they had. The researchers were also able to classify the genes of 139 of these women's babies.

As expected based on previous studies, only a handful of white women--2%--had the gene version that allows a woman to metabolize more alcohol.

Surprisingly, though, 46% of African-American women had this version of the gene. The researchers had expected that about 33% of black women would have this form of the gene.

Women with this version of the gene were more likely to give birth to a child with signs of fetal alcohol syndrome, including facial defects and developmental delays. The risk of these effects was higher even when researchers took into account several other factors, including how much weight a woman gained during pregnancy or whether she smoked or abused drugs.

The gene variant may increase the risk that alcohol will affect a fetus by giving women a higher tolerance, allowing them to drink more, according to the report. Women with this version of the gene did drink more during pregnancy, although the difference was not statistically significant.

Source: Journal of Pediatrics 2002;141:780-785.

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Enzyme Exacerbates Heart Disease

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- An enzyme called ACAT2 that is found only in the intestines and liver triggers hardening of the arteries in mice.

So says a study in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites).

The finding by researchers at Wake Forest University Baptist Medical Center and the University of California, San Francisco, may help scientists develop new drugs to treat atherosclerosis in humans.

The researchers compared mice that lacked the gene that makes ACAT2 to mice with normal ACAT2 levels. They found that the mice without ACAT2 had almost no development of atherosclerosis and had cholesterol levels 2.5 times lower than mice with normal ACAT2 levels.

The researchers note that monkeys with elevated ACAT2 in the liver are more susceptible to hardening of the arteries.

More information

The American Heart Association (news - web sites) has more about atherosclerosis.

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Think You're a Pro? You May Overestimate Ability

 

By Alison McCook

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - New study findings show that if you think you're a pro at math, chances are you'll guess you aced your math test--even if you bombed it.

Conversely, people who doubt their abilities will often underestimate their performance. These findings may help explain why women tend to avoid careers in science more often than men, even if the two sexes have equal ability, according to study authors Drs. Joyce Ehrlinger and David Dunning at Cornell University in Ithaca, New York.

"Surprisingly, these views we have about ourselves aren't necessarily tied to our performance," Dunning told Reuters Health.

Carrying false estimates of our abilities can be harmful, Dunning added. Underestimations of performance are the exception, he noted, for most people tend to think of themselves as better at something than they really are.

This thinking can cause people to expect to ace a test, and therefore forgo studying and do poorly, Dunning suggested. Some may believe they are in perfect health, and therefore don't feel the need to visit a doctor until they fall deathly ill. Others may delude themselves into thinking their marriages are in perfect shape, and are blindsided when a spouse hands them divorce papers, he added.

In one experiment, 91 students who said they believed they were good at abstract reasoning took a test that included instructions that said that high scorers are either good at abstract reasoning or good at computer programming. Although the two tests were identical, those who received the test that appeared geared toward programming had lower expectations about their scores than did the other group, although both groups scored equally well.

To test whether these findings could help explain the persistent gender gap in science careers, Ehrlinger and Dunning asked 119 students to complete a scientific reasoning test.

They found that women were more likely than men to say they performed poorly in science in general. The women also predicted they would score lower than men on the scientific reasoning test, both in raw score and relative to other students. However, as the authors report in the January issue of the Journal of Personality and Social Psychology (news - web sites), both sexes performed equally well on the test.

In an interview, Dunning explained that people can develop inaccurate self-views when they don't pick up clear cues about how well they are doing. For instance, a person who believes he is a good public speaker is not likely to see an audience walk out during his presentation. Rather, even if audience members are daydreaming or frozen in embarrassment for his sake, in his mind, they may simply appear to be listening.

Even if women ace every test in high school, once they continue studying, feedback becomes less straightforward, Dunning noted. Women who continue to study science may begin to underestimate their scientific abilities if their supervisor takes longer to return their E-mails than male students, or shows less excitement at female workers' ideas, Dunning added.

And when people encounter a scientific concept they don't understand, men may think nothing of it, while women may believe they are living up to the stereotype that women do poorly in science.

"Those stereotypes can have an impact, even if you don't believe them," Dunning said.

Without clear feedback from others, it is often hard to accurately know how well you are doing at any task, Dunning noted. He advised that people who want to be aware of their true abilities ask for feedback from others. "You can't go it alone," he said. "It's important to get outside feedback."

Source: Journal of Personality and Social Psychology 2003;84:5-17.

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Alzheimer's Disease May Be in the Genes

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- A genetic mutation that may be associated with an increased risk of developing Alzheimer's disease (news - web sites) has been identified by Swiss researchers.

The gene is called CYP46, according to a study in the January issue of the Archives of Neurology. It produces a protein that helps the brain metabolize excess cholesterol. Lower brain cholesterol levels reduce concentrations of proteins called beta-amyoloids, which have been shown to contribute to development of Alzheimer's disease.

In this study, the researchers examined the relationship between CYP46 and beta-amyloid and other biological traits associated with Alzheimer's disease.

They collected brain tissue samples from 55 deceased people without dementia, 38 samples of spinal fluid from living people with Alzheimer's disease, and 25 samples of spinal fluid from living people without Alzheimer's disease.

The Swiss researchers also looked at the association between the mutation of the CYP46 gene and Alzheimer's disease in 201 people with Alzheimer's and 248 people without the disease.

They found that CYP46 gene mutations were associated with higher concentrations of beta-amyloid in the brain and spinal fluid. The study also found that people with mutated CYP46 genes had twice the risk of developing late-onset sporadic Alzheimer's disease.

More information

Here's where you can learn more about Alzheimer's disease.

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Preemie Surgery Can Lead to Breast Deformities

By Alison McCook

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Some teenage girls may be at risk for breast deformities due to a procedure once commonly used to prevent lung collapse in premature babies, according to a group of Austrian researchers.

When babies are born prematurely, they often have immature lungs and can't breathe on their own. In some cases, however, mechanical respirators can accidentally rupture a baby's lung, causing air to collect in the chest outside of the lung.

In the past, doctors would often insert a drain through the baby's chest to evacuate the excess air.

However, when the drain is placed through the baby's breast tissue, a scar can form, according to Dr. Christian Rainer of the University of Innsbruck and Ludwig-Boltzmann Institute for Quality Control in Plastic Surgery and colleagues. When the baby girl gets older and begins to grow breasts, the scar can cause the breasts to become obviously misshapen.

In the January issue of Pediatrics, Rainer and colleagues describe the cases of two girls who needed plastic surgery to correct the problem.

In one instance, a 16-year-old girl underwent plastic surgery to correct the shape of both of her breasts. She was born prematurely and needed to stay on a ventilator for seven weeks, during which time she received multiple chest drains on both sides of her body. The deformities were embarrassing for her, the authors note, and she was teased because of them.

In the other case, the authors describe a girl who was also born prematurely, spent six weeks on a ventilator, and also received multiple chest drains. She later underwent plastic surgery to correct the shape of her breasts after adolescence. One year after surgery, her breast tissue appeared normal.

Although these types of breast deformities can be corrected with plastic surgery, the problem is very distressing for the women who experience it, the authors note.

Dr. Adeen Moore of the Hospital for Sick Children in Toronto, Canada, who reviewed the study for Reuters Health, said that chest drains became less common once doctors began using surfactant, a slippery substance that opens up the airways.

Babies born prematurely can lack naturally-occurring surfactant, she noted, so doctors now often deliver extra surfactant into their airways to help them breathe.

"Now that we have surfactant, it's much less common to have to use chest drains," Moore said.

She added that doctors who operate on premature babies are also now more aware of the dangers of damaging breast tissue, and try to avoid any procedures that may lead to long-term deformities.

That said, she said there are likely some young girls who received chest drains as babies who may eventually notice their breasts are not developing the way they should. Moore said that it would be better to warn a girl of the risk of deformities in advance, before she reaches puberty.

"If your family or pediatrician have prepared you, it would be a lot easier," she said.

Source: Pediatrics 2003;111:80-86.

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Doctors Urged to Watch Diabetics' Legs

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Monday, January 20, 2003

MONDAY, Jan. 20 (HealthScoutNews) -- Aggressive treatment to lower blood pressure in diabetics (news - web sites) with clogged leg arteries significantly reduces the risk of heart attacks and strokes, researchers say.

In a study published in the Jan. 21 issue of Circulation, the researchers say clogging of leg arteries, though often overlooked by primary-care doctors, can be a sign of serious coronary disease.

Diabetes and high blood pressure are key risk factors for peripheral arterial disease (PAD), a form of atherosclerosis that affects arteries leading to the legs and feet, say the researchers from the University of Colorado Health Sciences Center.

Giving blood pressure-lowering medications to those who have Type II, or adult-onset, diabetes and peripheral arterial disease substantially reduced the risk of heart attacks and strokes, the study says.

For five years, the researchers followed 950 people with adult-onset diabetes, including 53 with PAD.

Of the 53 patients with PAD, 22 in an "intensive treatment" group received the blood-pressure medications enalapril or nisoldipine, and 31 in a "moderate treatment" group received placebos. Among those who received the medications, three, or about 14 percent, had strokes or heart attacks, compared with 12, or nearly 39 percent, of those who did not take the medications.

"PAD is very common, but it's under-recognized and under-treated," says Dr. William R. Hiatt, the report's senior author and a professor of medicine at the University of Colorado Health Sciences Center. "It often presents itself as leg cramping during exercise, and physicians don't tune in to it too much."

Measuring blood pressure in the ankle can provide a crucial early warning sign of coronary disease -- and give physicians a chance to reduce the risk of heart attack or stroke through intensive blood-pressure control, the study found.

"The point of this is if you've got [PAD] in your leg, it is a sign of severe coronary disease, even in the absence of a heart attack," Hiatt says. "What we're discovering is if you treat those people aggressively, you can prevent heart attack and stroke."

Researchers also used the "ankle-brachial index," which compares the blood flow in the arm and ankle arteries of patients, to detect PAD.

Those in the moderate treatment group with PAD had an increased risk of heart attack and stroke. However, those in the intensive treatment group with PAD had no clinically relevant increased risk of either.

Hiatt says the study provides more evidence of the importance of aggressive blood-pressure control for diabetics. He adds the type of blood pressure medication -- a calcium-channel blocker or angiotensin-converting enzyme inhibitor -- did not matter.

Dr. Michael Davidson, director of preventive cardiology at Rush Heart Institute in Chicago, says the study's findings underscore the need for aggressive treatment to lower blood pressure in PAD patients.

"Before this study came out, there was kind of an impression that we should do this, but now there is more evidence that we should do this," Davidson says.

"The point is not just to treat the risk factors" for heart attack and stroke, he said, "but to treat them aggressively. Just treating them moderately may not be enough."

PAD affects 8 million to 12 million Americans, the American Heart Association (news - web sites) says. Cholesterol-laden plaque builds up in the blood vessels and reduces blood flow to the legs. That limited blood flow can't meet the demand from legs when a person with PAD is walking or exercising, and that shortfall results in pain, aching and fatigue in the legs.

More information

For more on peripheral arterial disease, visit the American Medical Association or the American Academy of Family Physicians.

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Chemo May Keep Ovarian Cancer at Bay

 

By Keith Mulvihill

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Two large, newly released European studies suggest that women with early-stage ovarian cancer may do better if they receive chemotherapy immediately after undergoing surgery.

Both studies found chemotherapy reduced the risk of a cancer recurrence. One found the treatment increased survival, but the other did not.

However, the studies are not the final word on the benefits of chemotherapy following surgery, said Dr. Debbie Saslow, of the American Cancer Society (news - web sites), who was not involved in either study.

"Women still need to discuss their particular situations with their doctors and decide about which course of treatment may be best for them," she told Reuters Health.

Currently, women diagnosed with early-stage ovarian cancer tend to have surgery and if the cancer comes back, additional surgery and chemotherapy are recommended, according to Saslow, director of breast and gynecologic cancer at the American Cancer Society. In about 50% of cases, women with early-stage cancer experience a relapse after surgery.

Previous studies have shown that some women with early-stage ovarian cancer can be cured by surgery alone and therefore can avoid the devastating side effects of chemotherapy.

One important factor is to determine how far the disease has progressed so an informed decision can be made, Slaslow explained.

In the first study, the International Collaborative Ovarian Neoplasm Collaborators led by Dr. Mahesh Parmar of the Medical Research Council Clinical Trials Unit in London, England looked at 477 women who either had chemotherapy after surgery or had surgery alone.

After five years, women who received chemotherapy had a 9% greater overall survival (79% versus 70%) and an 11% greater chance of not having a recurrence of their cancer (73% versus 62%), according to the report published in the January 15th issue of the Journal of the National Cancer Institute (news - web sites).

In the second study, 448 women with early-stage ovarian cancer had either chemotherapy and surgery or had surgery alone.

In this study, after 5.5 years no difference in overall survival was detected between the two groups of women. However, women who got chemotherapy were less likely to have their cancer come back, according to the study's lead author, Dr. J. Baptist Trimbos of Leiden University Medical Center in The Netherlands and colleagues.

Overall, 76% of patients treated with chemotherapy were recurrence-free compared with 68% of patients not treated with chemotherapy.

In an accompanying editorial Dr. Robert C. Young of the Fox Chase Cancer Center in Philadelphia, Pennsylvania, writes that the two trials "add important information" on the subject, "but leave some critical issues unresolved." While the two studies would seem to be "definitive proof" of the benefit of chemotherapy, "they are not," he writes.

The trials included a mix of patients, some with a poor prognosis and others with a better prognosis, based on the types of tumors they had. The studies do not help determine which women can be spared chemotherapy, according to Young.

More research needs to be conducted to better identify women "who do not require additional therapy, while also seeking to improve therapy in patients who do."

Source: Journal of the National Cancer Institute 2003;95:94-95,113-132.

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One in Five Depressed People Have Tried Suicide

 

By Richard Woodman

Reuters Health

Monday, January 20, 2003

LONDON (Reuters Health) - About one in five depressed patients attempt suicide and 47% think about suicide before their condition is diagnosed, according to a survey of psychiatrists released on Monday.

Datamonitor said the findings, based on interviews with 220 psychiatrists in the US, France, Germany, Italy, Spain, Japan and the UK, showed how the stigma of depression was stopping patients from seeking therapy.

A spokesman for Britain's Royal College of Psychiatrists said he was not surprised by the high rate of reported suicide attempts. Most people with depression probably never sought help, he said.

The Datamonitor report on the $14 billion anti-depressant market says that aside from a depressed mood, sleeping disorders are the most common symptom of depression, with 82.1% of diagnosed patients suffering from this problem.

The report notes that 51% of patients treated for depression also have at least one anxiety disorder. The most common was generalized anxiety disorder, affecting 30% of patients, followed by panic disorder (22%), social anxiety disorder (19%), agoraphobia (16%) and premenstrual dysphoric disorder (14%).

Research also showed that 38% of patients with depression are addicted to smoking, 21% are alcohol dependent, 15% have a substance abuse disorder, 9% have bulimia nervosa and 13% have binge eating disorder.

Datamonitor analyst Nick Alcock said these areas had not been actively targeted by antidepressant manufacturers, and represented commercial opportunities.

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New Breast Cancer Gene Discovered

 

By Linda Carroll

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - A newly discovered gene--and the protein it encodes--may lead to new weapons in the war against breast cancer (news - web sites), researchers say.

The protein is secreted only by breast cancer and salivary gland cells, making it a potential target for therapies and diagnostic tests, according to a report published Monday in the Proceedings of the National Academy of Sciences (news - web sites) early edition.

Researchers named the protein BASE, an acronym for breast cancer and salivary gland expression.

"We're trying to find targets for breast cancer treatment," study co-author Dr. Ira Pastan said in an interview with Reuters Health. "Genes that encode proteins such as this might be used to diagnose cancer early or to follow patients to see how they are responding to treatment or as a target for some kind of immunotherapy," said Pastan, who is the chief of the molecular biology laboratory at the National Cancer Institute (news - web sites) in Bethesda, Maryland.

Pastan and his colleagues located the gene and its associated protein through an exhaustive search through DNA associated with breast tumors.

First, the researchers created a library of more than 15,000 genes that came from breast cancer cell lines, prostate cancer (news - web sites) cells and normal breast cells, said Kristi Egland, the lead author of the study and a postdoctoral fellow in Pastan's lab.

"Then we removed all the genes that are also expressed in essential tissue, such as the brain, the liver, the lungs and the kidneys," Egland said. "That left us with about 3,000 to 4,000 genes."

To narrow the search even further, the researchers focused in on genes that showed up multiple times.

"Some genes have many copies," Egland explained. "They are highly present." One of those "highly present" genes was BASE, Egland said.

As it turns out, the gene that encodes BASE is found in about 30% to 40% of breast cancers, Pastan said.

"The normal breast make very little if any of the protein," he added. "But when there are certain kinds of breast cancer, quite a lot of it is made."

The researchers hope that they will be able to use the new information to devise a breast cancer screening test.

"What you want to do is to try to measure the levels of BASE in the blood," Pastan explained. "This could help you diagnose breast cancer, like PSA levels are used to diagnose prostate cancer."

Scientists might also be able to use BASE as a target for therapies, Pastan said. "It could be a vaccine target," he added. "Because it's not made in essential tissues, you might be able to come up with a vaccine that would destroy the cells that make it."

Because BASE is also present in the salivary gland, such a vaccine could have the side effect of dry mouth, Pastan said. "But if you've got metastatic breast cancer, it might be worth the risk," he added.

The study was funded in part by a Cooperative Research and Development Agreement with the IDEC Pharmaceuticals Corporation.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0337425100.

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Asthma Attacks More Common on Foggy Nights

 

By Stephanie Riesenman

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Checking the weather forecast may help ward off asthma attacks in children, since misty or foggy nights can exacerbate symptoms, according to a new study.

A group of Japanese researchers led by Dr. Kosuke Kashiwabara of Taragi Municipal Hospital in Kumamoto, Japan, gathered data from a hospital in Kyushu, the southernmost large island in Japan. The researchers found that there were 50% more emergency room visits by asthmatic children on misty or foggy evenings compared to clear nights.

Children with asthma were more than four times as likely to visit the emergency room when temperatures rose above 17.7 degrees Centigrade (63 degrees Fahrenheit). There also tended to be more ER visits by asthmatic kids on days with lower barometric pressure. The findings are published in a recent issue of the Journal of Asthma.

The age of the asthmatic children ranged from 7 months to 15 years. At the hospital, the kids were treated for wheezing, shortness of breath and/or rapid breathing.

Dr. Stanley Goldstein, a representative of the American Academy of Allergy, Asthma & Immunology, told Reuters Health that people with asthma have "airways that are hyper-reactive, which means they are sensitive to irritants in the environment that are breathed in, and fog and mist are definitely irritants."

The researchers say in their study, "it is not clear whether or not airborne water droplets alone contained in mist and fog affect the bronchoconstriction of asthmatic children." Changes in atmospheric pressure, they say, may also contribute to exacerbation of asthma. According to Goldstein, research has shown that asthma symptoms are also more common on humid days.

Asthma tends to become worse in the evening, said Goldstein, because kids are at home and in their bedrooms, which are often loaded with dust mites, a well-known asthma trigger. Another theory about the nighttime rise in symptoms, he added, is that the body's production of steroids is decreased in the evening, and since corticosteroids are known to relieve asthma, it's not surprising to see more asthma attacks at night.

Many children in the United States rely on inhalers, which they often use at home instead of going into the emergency room for treatment.

The researchers note that in Japan, inhalers are "not encouraged for asthmatic children because it has been reported that the overuse was associated with an increased risk of death from asthma." However, they conclude that efforts to prevent asthma attacks would reduce the number of hospital visits in Japan.

Source: Journal of Asthma 2002;39;711-717.

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Water-Filtered Infrared Light Fights Warts: Study

 

By Hannah Cleaver

Reuters Health

Monday, January 20, 2003

BERLIN (Reuters Health) - Water-filtered infrared light is an effective and painless means of removing warts, according to German dermatologists who report positive results from a small clinical trial.

Dr. Silke Fuchs from the Jena University dermatology clinic said that when infrared radiation is conducted through water, its long-wave parts are filtered out in favor of the short-wave IR-A band.

This is said to result in a reduced risk of superficial burns and a better penetration into tissues.

"This special infrared light penetrates particularly deep into the skin," she said in a statement. Heating the wart increases blood flow and stimulates an immune response to the human papillomavirus.

Fuchs and her team, led by dermatology Professor Peter Elsner, conducted a clinical study on 80 patients with warts that had resisted other treatments.

Participants were either treated with the water-filtered infrared therapy or with a "placebo" light. Of those who had the infrared treatment, more than 80% displayed a clear reduction in wart-covered area. One third of those given placebo light showed reduction.

Further treatment with 5-aminolevulinic acid (5-ALA), a chemical used in light-activated therapy, did not result in further improvement, Fuchs reported at a presentation last month at a symposium at the Braun Foundation in Luzern, Switzerland.

She reported there were no side-effects from the infrared light treatment, saying the function was to revitalize and strengthen the local immune system with the light by increasing blood flow to the wart, which is often disrupted.

Elsner said he hoped the technique would be taken up by dermatologists, and that public health insurers would add it to their lists of treatments for which they pay.

"This new therapy should be suited above all for children who have been unsuccessfully treated with other methods. Admittedly at the moment the state insurers do not cover the costs. But it is to be hoped that they will take on this good-value treatment in the future."

Water-filtered infrared light is also used in some areas of oncology, most successfully with superficial tumors up to one centimeter under the skin.

Scientists at the Mainz University Institute for Physiology and Pathophysiology have reported promising results from animal experiments looking at the treatment for larger and deeper tumors, largely in conjunction with chemotherapy and radiotherapy.

"The warming effect is limited, though, as one has to reach temperatures of more than 41 degrees to get cell-kill and that is not so simple with many tumors as the blood flow tends to dissipate the heat," Dr. Debra Kelleher from the institute told Reuters Health.

Hyperthermic therapy is rarely used in the US, Kelleher noted, when there is some other way to deal with a tumor, such as removing it surgically. "But in Europe use of the therapy is relatively stable," she added.

German firm Hydrosun, which manufactures the equipment used in the Jena study, states that the water-filtered infrared light therapy can be used for a wide range of other indications including chronic, degenerative joint disease; nerve inflammation and pain; back problems; scar tissue; and sinus and circulatory problems.

"The expanding use of this relatively new therapeutic modality has revealed its efficacy for the treatment of cutaneous precancer and cancers, as well as selected benign skin disorders," a company statement says.

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Crash Victim's Face Injury May Signal Brain Injury

 

Reuters Health

Monday, January 20, 2003

NEW YORK (Reuters Health) - Motorcycle riders who injure their faces or fracture face bones are much more likely to have brain injury than those who do not sustain facial injuries during an accident, new study findings show.

Although there has been much study on the care of facial injury among accident victims, there has been little investigation into other injuries associated with damage to the face, according to lead author Dr. Jess F. Kraus of the UCLA School of Public Health in Los Angeles, California.

To investigate, the team of researchers evaluated the medical records of 5,790 motorcycle riders injured in crashes between 1991 and 1993. They report their findings in the January issue of the journal Annals of Emergency Medicine.

In all, nearly one in four injured riders had a facial injury, including 411 riders who each had at least one facial fracture, according to the report.

"The odds of traumatic brain injury were 3.5 times greater with than without a facial injury and 6.5 times greater with a facial fracture than with no facial injury," the authors write.

"The findings of this study support previous research demonstrating an association between facial fractures and traumatic brain injury," the authors write.

As a result, the authors are recommending that emergency room doctors screen all motorcyclists with fractures of face bones for brain injury, regardless of whether they were wearing a helmet at the time of their crash.

Motorcycle riders may be able to minimize the risk of brain injury by wearing full-face motorcycle helmets, the authors conclude.

Source: Annals of Emergency Medicine 2003;41:18-26.

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SUNDAY, JANUARY 19, 2003

Glaucoma: Straight Talk About a Dangerous Disease

 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Sunday, January 19, 2003

SUNDAY, Jan. 19 (HealthScoutNews) -- Rajia Idris had struggled with vision problems for much of her life, but she never thought she'd go blind.

The 46-year-old San Franciscan started having problems with her eyes at age 9. By 17, she was diagnosed with glaucoma. Idris could see, however, and she wasn't going to let glaucoma slow her down.

She lived actively, as if nothing were wrong, until her mid-20s, when she lost all sight in her right eye and could barely see out of the left one. Finally, she realized she'd have to begin her life again, without vision.

"I knew I was going through glaucoma, but I never in my wildest dreams thought I was going blind," Idris says. "Then I couldn't see, and I realized I had no choice. I didn't want to go, but I had to go to the blind school."

"It's like relearning how to live," she adds. "I had to learn Braille, and how to use a cane to get around. They teach you how to cook and sew a button without using your eyes."

While Idris suffers from an aggressive form of glaucoma, her experience isn't uncommon. An estimated 3 million to 4 million Americans have the sight-robbing disease, making it the second leading cause of blindness in the United States, behind macular degeneration.

However, half of those with glaucoma don't even know it, and the number afflicted in America is expected to double or triple during the next 30 years as the population ages.

Although recent advances in treatment and diagnosis have greatly improved the chances that those with glaucoma won't lose their sight, it has to be detected early. Unfortunately, the main symptom of glaucoma, loss of peripheral vision, usually doesn't appear until it's too late, which is why the illness is often referred to as the "silent thief of sight."

"The greatest sadness for me is that people don't come in early enough," says Dr. Andrew Iwach, an ophthalmologist and assistant professor at the University of California, San Francisco.

Because January is Glaucoma Awareness Month, eye doctors emphasize that people in high-risk groups -- including blacks, who are six to eight times more likely to get glaucoma; the elderly, of which 2 percent have glaucoma; or those with a family history of the illness -- should schedule eye tests to catch the "silent thief" before it sets in. New, more accurate tests let ophthalmologists detect glaucoma much earlier than in the past.

Glaucoma is most often caused by the buildup of fluid in the eye. In a normal eye, fluid cycles through continuously, nourishing the pupil, lens, iris and other essential components. However, if the drainage passage is clogged, the fluid builds up, increasing pressure in the eye.

"It's kind of a plumbing system. Part of it is a faucet and part of it is the drain, which sometimes gets clogged," says Dr. Martin Wax, head of ophthalmology research at the Pharmacia Corp. in St. Louis and a professor at Washington University School of Medicine.

The elevated pressure then pushes on the optic nerve in the back of the eye. The nerve, which has about 1 million strands, carries a visual signal from the eye to the brain. Over time, this pressure damages many of strands in the nerve, reducing the field of vision communicated to the brain. First peripheral vision goes, then straight-ahead vision, and the damage is irreparable.

"The higher the pressure, the shorter the amount of time it takes to damage the visual cortex," Wax says. "It's early detection that is the key. There are very few reasons that a person should go blind from glaucoma if it is detected early."

Once detected, glaucoma is often treated with medicated eye drops, laser surgery to improve fluid flow in the eye, or conventional surgery to open up new drainage openings.

"In many ways, we haven't improved upon the idea of draining the eye by making a hole where the fluid can drain. They started doing that in the early 20th century," Wax says.

As early detection improves, it becomes more and more important that people get eye tests, so they won't have to go through surgery.

Idris had gone through six different surgeries to try to improve her sight. Until three years ago, none of them was effective. However, a recent surgery helped slow the loss of sight in her remaining good eye, and released pressure in her eyes, easing accompanying headaches.

Still, Idris is legally blind, and can only make out the faintest images. However, she hasn't let that stop her from raising a family and tackling outdoor adventures.

"Of course, things are not hunky-dory all of the time," she says. "But it's like any grieving process, you have to eventually move on. Gradually you come to accept it, and you adapt. Now, I do things I never would have done. I do river rafting and tandem biking, and in February I'm going cross-country skiing in Alaska."

What To Do

To learn more about glaucoma awareness, read this brochure from the National Eye Health Education Program. For a detailed explanation of glaucoma, read this fact sheet by the National Eye Institute, or this one by the Glaucoma Research Foundation.

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Lift With Care

 

HealthScoutNews

Sunday, January 19, 2003

SUNDAY, Jan. 19 (HealthScoutNews) -- There's no better way to ruin a vacation than by lifting your luggage incorrectly. One wrong move can throw your back into a spasm of pain you won't want to carry with you.

Think about purchasing luggage with wheels or even a folding cart that can pack up and go with you. When you do need to lift your bags, follow these tips to keep your back in tip-top shape:

         Don't lift objects that weigh more than 30 pounds, warns the Cleveland Clinic.

  • Only lift objects that are lower than your waist.
  • Before lifting, make sure you have a firm footing by placing your feet about eight to 12 inches apart.
  • Bend at the knees, not at the waist, keeping your back straight. Don't twist at the waist.
  • Tighten your stomach muscles and use your leg muscles to lift.
  • Straighten your knees with a smooth, fluid motion.
  • Make sure you keep breathing steadily and that your movements are smooth and steady.
  • When you stand up, again bend only at the knees.
  • Keep the suitcase near your body, not away from you.
  • When you're ready to put it down, place your feet apart again, and bend at your hips and knees.
  • Another option, recommended by the North American Spine Society, is to kneel on one knee with the other foot flat on the floor. Then stand up while keeping the suitcase as close to your body as possible.

More information

Read more about back injuries from the American Academy of Orthopaedic Surgeons.

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Slip Sliding Away

 

HealthScoutNews

Sunday, January 19, 2003

SUNDAY, Jan. 19 (HealthScoutNews) -- When the weather outside is frightful, falling on ice can be less than delightful.

That's because even a minor fall can be serious, causing broken bones or even worse. Every year, more than 16,000 people -- most of them elderly -- die from falls, according to the National Safety Council.

Making sure your sidewalks and driveways are free of snow and ice is your best line of defense. However, no matter how careful you are, you'll probably still have to walk over some slippery spots during the winter months.

So, make sure you leave yourself enough time to get where you're going -- rushing will only make a fall more likely. Wear shoes or boots that offer traction. Try to avoid shoes with plastic or leather soles. Walk on cleared pathways as much as possible.

If you must walk on ice, shuffle or take small steps to help maintain your balance. Bend slightly forward and walk flat-footed, recommends the department of Environmental Health and Safety at Iowa State University. Also, keep your head forward, so if your feet slip out from under you, you'll be less likely to hit your head on the pavement. Be especially careful when you're getting in and out of the car -- use it for stability.

Finally, be ready for a fall and try not to use your arms to break your fall if you do start to go down.

More information

The U.S. Centers for Disease Control and Prevention (news - web sites) offers these tips on staying safe outdoors in the winter.

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SATURDAY, JANUARY 18, 2003 

When Boils Pop Up, Don't Pop Them

 

HealthScoutNews

Saturday, January 18, 2003

SATURDAY, Jan. 18 (HealthScoutNews) -- It's only natural that if a painful, red bump appears on your skin, you want to try to remove or pop it, but experts say it's best to resist the temptation.

The bump may very well be a surface abscess, better known as a "boil," and popping it could only make things worse.

Boils occur when white blood cells rush to attack bacterial germs that have invaded bodily tissues, says a report in the January issue of Mayo Clinic Health Letter.

The body's immune system gets into the act by "walling off" the pus that's formed and building an abscess around it. The next thing you know, you've got a boil.

While commonly seen on the skin, boils can in fact occur inside your body.

So if it's on your skin and you shouldn't pop it, what can you do?

The experts recommend applying a warm, moist dressing to relieve the pain and swelling. Trying to pop the abscess may in fact spread the infection. If the symptoms don't subside in a few days, seek medical attention.

An internal abscess can be a more serious situation, possibly causing fever for five days or more, unexplained weight loss, night sweats or other localized symptoms. In such cases, it's important to see a doctor as soon as possible to prevent enlargement of the abscess and the spread of the infection.

Treatment for an internal abscess typically involves antibiotics and draining the pus.

More information

Boils are especially common among athletes. Read more about boils, and other skin conditions, at the American Academy of Dermatology.

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Weighing In on Diet Plans

 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Saturday, January 18, 2003

SATURDAY, Jan. 18 (HealthScout News) -- If you've finally decided to lose that weight, you'll probably find yourself immersed in the Great Diet Debate.

Follow a high-carbohydrate diet and minimize fat, many experts advise.

Other experts argue that the surest route to weight loss is a low-carbohydrate diet with generous amounts of protein and fat.

The debate isn't likely to die down anytime soon. Both sides are convinced their plan is correct, the right way to lose weight and keep it off.

Dieters in a quandary can educate themselves on the merits of each plan, then consult with a physician and decide the best plan for them. And they can take heart that some diet experts say "high-carb" plans might be right for some people, while "low-carb" plans are best for others -- at least short-term.

"One size doesn't fit all," says Leslie Bonci, a dietitian who is director of sports nutrition at the University of Pittsburgh Medical Center and a spokesperson for the American Dietetic Association.

While low-carb diets that push plenty of protein (such as the Atkins diet or other high-protein plans) are perhaps the most popular weight reduction strategy of the moment, Bonci says, "body fat loss is not any faster on the high-protein diets. There is a little more rapid water weight loss, loss you see on the scale."

But, Bonic adds, "the overall fat loss is equivalent," whether dieters follow a high-protein plan or other diets, as long as they cut down on food intake sufficiently.

Another dietitian, Gail Frank, a professor of nutrition at California State University, Long Beach, says dieters tend to look on the low-carb, high-protein diets as a quick fix.

But, she notes, the high-protein plans will "trick you into feeling successful but won't give you the long-term success you want."

She blames people's fascination with the high-protein, low-carb plans for roller-coaster dieting. "They use it short term, get five pounds or so off, then go back to typical eating and gain all the weight back," she says. Soon they are dieting again, she adds.

Frank suggests a sensible eating plan, also recommended by other experts, that includes a diet of 50 percent to 55 percent carbohydrates (such as fruits and vegetables), up to 30 percent fat, and about 15 percent to 20 percent protein (including meat and fish) -- along with plenty of exercise to speed weight loss.

But those who advocate a high-protein diet say controlling carbohydrate intake is the key, especially in the initial stages of weight loss.

"When you control carbohydrates, you switch metabolic pathways so you burn fat for energy," says Colette Heimowitz, director of education and research at Atkins Health & Medical Information Services in New York City.

In the initial phase of the Atkins diet, she says, people can lose at least four pounds a week. But she says critics often don't understand that the Atkins plan has four phases -- the initial weight loss phase, the ongoing weight loss phase, the pre-maintenance phase and the lifelong maintenance phase.

Each phase varies, depending on how much weight a person needs to lose and how quickly it comes off, Heimowitz says. And, she adds, the maximums suggested by Atkins -- a diet of 35 percent protein, 60 percent fat and 5 percent carbohydrates -- still fall within the upper limit of protein consumption suggested recently by the National Academy of Sciences (news - web sites).

But critics contend that even short-term deficits in carbohydrates can be bad.

"Your brain absolutely needs carbs," says Evelyn Tribole, an Irvine, Calif., dietitian and author of numerous nutrition books. You need carbohydrates, she explains, to get the amino acid tryptophan into the brain. And tryptophan is crucial for maintaining levels of serotonin, which helps elevate mood, she adds.

"If you have a history of depression in your family, a low-carb diet can be bad news," Tribole says.

"And if you are on a low-carb diet, it is going to be hard to exercise," she adds, because carbohydrates are "energy" foods.

Before beginning any weight-loss plan, Bonci suggests you administer a quick survey of your eating habits. "Be really honest with yourself," she suggests. "What are you eating now? What are you willing to change?"

Think long term, not just in terms of what you will do in the coming weeks regarding your eating habits, but in the coming years. Realize that long-term weight control depends not just on healthful eating, but on regular exercise, she says.

And always get your doctor's OK before beginning a weight loss or exercise program.

What To Do

Jan. 19-25 is Healthy Weight Week.

For more information on diets and nutrition, see the U.S. Department of Agriculture and the American Dietetic Association.

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Winter Allergies: They're Real

HealthScoutNews

Saturday, January 18, 2003

SATURDAY, Jan. 18 (HealthScoutNews) -- Allergies don't just make people miserable in the fall, spring and summer. Winter is a time for suffering, too.

Molds are a primary culprit, according to the American Academy of Allergy, Asthma & Immunology. In some warm areas, they grow and thrive year-round, but even in cold climates, molds growing indoors can make your nose run.

It isn't the mold itself but the spores that are released into the air that cause problems.

In winter, other indoor allergens can proliferate, become airborne and stick around, especially with doors and windows shut. Offenders include animal dander and dust mites. Around the holidays, Christmas trees, both real and fake, can also set people off sneezing.

To stay sniffle-free, try to get rid of the allergens. For mold, that can mean cleaning with bleach. Try a solution of 5 percent bleach and a small amount of detergent to 95 percent water to clean household areas, advise experts from the academy.

If mold is visible -- in carpeting or wallpaper, for example -- it's best to remove the materials.

Try to keep a humidity level of 30 percent or 40 percent in the house to make conditions for mold growth less optimal.

To control animal dander, have a family member who's not allergic groom the animal frequently. Keep animals out of the bedroom of the affected person.

To control dust mites, clean and dust more frequently. Change bed linens often. Dust off the artificial tree before decorating it.

More information

More details on allergies are at the National Jewish Medical & Research Center.

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