Breast Cancer Gene Discovered
FRIDAY, JANUARY 24, 2003
Drug May Fight Lupus, Cancer
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
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
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.
where you can learn more about lupus.
Hand Transpant Patient Doing Well
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.
Drug May Help Smokers Quit
NEW YORK (Reuters Health) - A drug used to treat Parkinson's
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
"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,"
The study was funded by grants from the National Institute
on Drug Abuse, the National Cancer Institute (news
sites) and the Robert Wood Johnson Foundation.
Source: Biological Psychology 2003:53:136-143.
New Weapon Against Listeria
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
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
Here's where to learn more about Listeria.
Often Start Smoking Again After Pregnancy
By Charnicia E.
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
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,"
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,"
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.
(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
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.
Kids Have Medical Reason to Be Afraid of Dark
By Alison McCook
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,
"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.
More Pain, More Gain
(HealthScoutNews) -- The latest buzz is that short-intensity
exercise burns as much if not more calories as a longer, lower-intensity
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
Austrians May Have High Homocysteine
By Jane Burgermeister
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.
New Help for Enlarged Prostates
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.
Here's where you can learn more about prostate
Drug Linked to Heart Disease
By Alison McCook
NEW YORK (Reuters Health) - People with Parkinson's disease
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.
Having a Baby to Please a Guy
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
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,
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.
Here's where you can learn more about teenage
Enzyme Implicated in Artery Disease
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
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
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
New Guidelines Place More at Thyroid
By Amanda Gardner
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
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
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
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."
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.
Thyroid Association also has a wealth of information
Like a Drug in Heart Disease, Study Finds
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
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
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."
Rock-a-bye Baby, Sleep Through
By Jennifer Thomas
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
"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."
To read the American Academy of Pediatrics' guidelines for
League also has information about feeding infants.
Shown to Prevent Breast Cancer in Some Women
LONDON (Reuters) - The most widely prescribed drug for treating
breast cancer (news
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
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
"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.
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
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
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.
Here's where you can learn more about cachexia.
Warn of Possible New Risk for IVF Babies
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
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
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
A spokeswoman for the HFEA stressed that there was no reason
for parents of babies born through IVF to be concerned.
JANUARY 23, 2003
Lead Removal Improves Kidney Function
By Gary Gately
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
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
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
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
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,
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
Brain Sees Screen Flickers, Even if We Don't
By Alison McCook
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
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
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
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
Krolak-Salmon also holds a position at the Hopital Neurologique,
also in Lyon.
Source: Annals of Neurology 2003;53:73-80.
Study Backs Common Therapy for
By Kathleen Doheny
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
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
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
sites). About 2 percent of women with preeclampsia develop
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."
For more information on preeclampsia and eclampsia, try the
Library of Medicine or the Preeclampsia
Study Says Broken Homes Harm Kids More
By Emma Ross
AP Medical Writer
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
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
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
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
On the Net:
The Lancet, http://www.thelancet.com
to Blame When You Can't Match Face with Name
By Amy Norton
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
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.
New Patient Gets Artificial Heart
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
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.
Training Can Build Postmenopausal Bone
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
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
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
FDA Issues Warning on Asthma Drug
WASHINGTON - The Food and Drug Administration (news
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
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
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
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:
Reports Jump in Stomach Virus Outbreaks
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
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
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
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.
Calories Via Any Diet Regulates Hormones
By Alison McCook
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
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,"
Source: Journal of Clinical Endocrinology &
Drug Cuts Prostate Surgery Blood Loss
NEW YORK (Reuters Health) - A drug used by hemophilia patients
may also cut blood loss in prostate cancer (news
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.
a Lot of Sleep? Blame It on Body Clock
By Merritt McKinney
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
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
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
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
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
Source: Journal of Clinical Endocrinology and Metabolism
Brain Compounds Affect Drinking Desires
By Merritt McKinney
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
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
"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
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
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
WEDNESDAY, JANUARY 22,
Much Vitamin A Boosts Risk of Broken Bones
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
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
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
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.
Domestic Violence Victims See Doctor
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.
Here's where you can find out more about domestic
Acid Mix Shields Blood Vessels
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
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
Source: Proceedings of the National Academy of Sciences
Help Prevent Colic Attacks
(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
- 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
- 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.
Menopause Not Always 'Unnatural': Study
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
"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
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
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
Bipolar Disorder More Common Than
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
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 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.
Here's where you can learn more about bipolar
Technique May Boost Memory: Study
By Stephen Pincock
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,
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
International Journal of Psychophysiology 2003;47:75-85.
Can Be Death Knell in Heart Condition
By Ed Edelson
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
"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
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,"
"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.
You can learn more about hypertrophic cardiomyopathy from the
Institutes of Health or the Hypertrophic
Loss Surgery Changes Food Preferences
By Alison McCook
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
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
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
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.
TV Soothes Low Self-Esteem
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
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.
Much attention is given to how television affects us. This
site discusses children and violence
Food Diet Brings Scurvy to Modern Age
By Alison McCook
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
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,"
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
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
Lasers Zap Varicose Veins for Good
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
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.
Here's where you can learn more about varicose
Increases Seen in '03 U.S. Bio-Corn, Soy Crops
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
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
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
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
According to US Agriculture Department (news
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
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
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
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
Tots Tune Into TV
By Janice Billingsley
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,"
"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,"
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
Dye Helps Huntington's-Like Disease in Mice
By Alison McCook
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
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.
Up Lead from Body Helps Ailing Kidneys
By Amy Norton
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
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
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
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
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,
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.
Drug Still Best at Pregnancy Seizure Prevention
By Alison McCook
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
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
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
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
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.
Remedy Eases Perils of Primate Pregnancy
LONDON (Reuters) - Never underestimate the intelligence of
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.
also swallow leaves whole to induce diarrhea to get rid of
tapeworms and other parasites.
JANUARY 21, 2003
Doctors Behind the Times
By Randy Dotinga
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
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
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,"
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
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."
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.
Seen Undertreated for Heart Disease
By Michael Rubinkam
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
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
sites) from using hormones far outweighs any health benefits.
On the Net:
Annals of Internal Medicine: http://www.annals.org
Heart Association (news - web sites): http://www.americanheart.org
Much on Your Plate? U.S. Food Portions Balloon
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
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
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
Alzheimer's, Cholesterol Gene Linked
By Lindsey Tanner
AP Medical Writer
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
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
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:
Alzheimer's Association: http://www.alz.org
Scientists Discover Migraine Gene
By Rachel Sanderson
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"
"The chromosome is so well researched, it will not be
difficult or take long to find a therapy for it," Casari
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
"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.
Infants and Stroke: A Very Real
By Jennifer Thomas
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.
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
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
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
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
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
"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
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.
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.
Independence Key to Job Happiness, Not Pay
By Anthony J. Brown,
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
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
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,
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
(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.
of Day Affects Drug's Blood Pressure Control
By Keith Mulvihill
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
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
"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
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.
Thalidomide Proving Its Mettle
as Cancer Fighter
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
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
sites) for the treatment of myeloma.
Here's where you can learn more about multiple
Lack Incentives for Improving Patient Care
By Karen Pallarito
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
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
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
"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
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
Half of the physician organizations in the study used no more
than four of the 16 processes surveyed. Nearly one in six
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
"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
Source: Journal of the American Medical Association
Gene Therapy Helps Poor Circulation
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
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
As many as 40 percent of those people must have leg amputation,
and one in five dies within six months, the researchers say.
Here's where you can learn more about atherosclerosis
in the legs.
JANUARY 20, 2003
(HealthScoutNews) -- Snow shoveling often is a riskier activity
for men than women, says the Harvard Medical School (news
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.
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.
Colorectal Exam Likely if Sedated First Time
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
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,
Of those who had sigmoidoscopy, 58% reported that they had
discomfort during the exam and 16% reported discomfort after
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
"Patients were also significantly more willing to undergo
subsequent screening colonoscopy than screening sigmoidoscopy,"
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
(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.
Kids More Resilient Than Adults with Injury
By Alison McCook
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
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
"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
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%
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.
Link to SIDS Found
By Serena Gordon
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
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
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
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
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,"
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."
For information on lowering your child's risk of SIDS, visit
SIDS Institute or the SIDS Alliance.
Gas May Improve Angioplasty Results
By Merritt McKinney
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
sites) in Boston, Massachusetts, released the findings
Sunday in the advance online edition of the journal Nature
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
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.
The Smell of Strong Emotions
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
Here's where you can learn more about the workings of your
Intake Not Linked to Dementia Risk: Study
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
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
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.
New Heart Therapy May Spare Surgery
By Ed Edelson
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
"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,
A formal trial aimed at getting U.S. Food and Drug Administration
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."
You can learn about heart valves, their problems, and repairs,
from the American
Heart Association or the Society
of Thoracic Surgeons.
Blood May Aggravate Restless Legs Syndrome
By Merritt McKinney
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
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
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.
By Nancy Deutsch
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
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
"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
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,"
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.
For more on melanoma, go to the Melanoma
Patients' Information Page. Check out sentinel lymph node
biopsy at the National
Linked to Alcohol Risk in Pregnancy
By Merritt McKinney
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
"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
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
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.
Enzyme Exacerbates Heart Disease
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
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
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.
The American Heart Association (news
sites) has more about atherosclerosis.
You're a Pro? You May Overestimate Ability
By Alison McCook
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
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
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
Alzheimer's Disease May Be in the
MONDAY, Jan. 20 (HealthScoutNews) -- A genetic mutation that
may be associated with an increased risk of developing Alzheimer's
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
Here's where you can learn more about Alzheimer's
Surgery Can Lead to Breast Deformities
By Alison McCook
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
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
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.
Doctors Urged to Watch Diabetics'
By Gary Gately
MONDAY, Jan. 20 (HealthScoutNews) -- Aggressive treatment to
lower blood pressure in diabetics (news
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
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
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
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.
For more on peripheral arterial disease, visit the American
Medical Association or the American
Academy of Family Physicians.
May Keep Ovarian Cancer at Bay
By Keith Mulvihill
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
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
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
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
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,"
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
in Five Depressed People Have Tried Suicide
By Richard Woodman
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
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
Breast Cancer Gene Discovered
By Linda Carroll
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
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
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
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
sites) cells and normal breast cells, said Kristi Egland,
the lead author of the study and a postdoctoral fellow in
"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.
of the National Academy of Sciences 2003;10.1073/pnas.0337425100.
Attacks More Common on Foggy Nights
By Stephanie Riesenman
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
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
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.
Infrared Light Fights Warts: Study
By Hannah Cleaver
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
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
"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.
Victim's Face Injury May Signal Brain Injury
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
"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
Annals of Emergency Medicine 2003;41:18-26.
SUNDAY, JANUARY 19,
Straight Talk About a Dangerous Disease
By Ross Grant
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
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
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
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
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
"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
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
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
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
Don't lift objects that weigh more than 30 pounds, warns the Cleveland
- 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
- 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
- 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.
Read more about back injuries from the American
Academy of Orthopaedic Surgeons.
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
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.
The U.S. Centers for Disease Control and Prevention (news
sites) offers these tips on staying
safe outdoors in the winter.
SATURDAY, JANUARY 18, 2003
Boils Pop Up, Don't Pop Them
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
The bump may very well be a surface abscess, better known as
a "boil," and popping it could only make things
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
So if it's on your skin and you shouldn't pop it, what can
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.
Boils are especially common among athletes. Read more about
boils, and other skin conditions, at the American
Academy of Dermatology.
In on Diet Plans
By Kathleen Doheny
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
Other experts argue that the surest route to weight loss is
a low-carbohydrate diet with generous amounts of protein and
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
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
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
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
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
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
Allergies: They're Real
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
More details on allergies are at the National
Jewish Medical & Research Center.