The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
October 22, 2003

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of July 5-11

FRIDAY, JULY 11, 2003

  1. Inflammation Linked to Cognitive Decline
  2. Skip Breakfast, Get Fat
  3. New Insight into Graves Disease
  4. Is Inactivity Causing Diabetes among Kids?
  5. Upper-Ear Piercing
  6. The Test Expectant Moms Shouldn't Skip
  7. Heart Failure Common in Pacemaker Patients
  8. ‘Watchful Waiting' Best for Infections in Newborns
  9. Arthritis Outlook Worse for Women
  10. U.S. Team Finds Hints of How, Why Cancer Spreads
  11. Food May Trigger Life-Threatening Asthma

    THURSDAY, JULY 10, 2003

  12. New Hope for Peanut Allergy Sufferers
  13. Surgery Not Needed for Many Brain Aneurysms
  14. Get All the Facts on Breast Cancer Screening
  15. Breakthrough for Muscular Dystrophy
  16. More Schooling Leads to Smarter Eating
  17. A Closer Look at Autism
  18. New Treatment for Blood Clots
  19. Air Sick?
  20. Deep-Vein Thrombosis
  21. FDA Orders Revised Epilepsy Drug Warning
  22. New Blood Test May Help With MS Diagnosis
  23. FDA Loosens Food Label Requirements

    TUESDAY, JULY 8, 2003

  24. Child-Friendly Drug Repellant
  25. Group Targets Stroke Death Rate in South
  26. Heart Disease, Not Always a Death Sentence
  27. Anti-Malaria Pill Comes with Risk Guide
  28. Drug Cuts Blood Clot Risk in Cancer Patients
  29. Chromosome Linked to Deafness, Lymphomas Sequenced
  30. New Blood Test May Help with MS Diagnosis
  31. Bad Gene Ups Prostate Cancer Risk in Black Men
  32. Government Requires Trans-Fat Labels on Food

    MONDAY, JULY 7, 2003

  33. Macular Degeneration
  34. Is It Anorexia Nervosa?
  35. Urinary Tract Infection Germ Impervious
  36. Chilling Heart Patients Saves Their Brains: Study
  37. FDA OKs New Device to Manage Diabetes
  38. Studies Predict Outcome of Kidney Transplants
  39. Brushing Right After Drinking Soda May Harm Teeth
  40. What to Watch for with West Nile Virus
  41. S.C. Man Has First U.S. Case of West Nile
  42. Death Rate Higher on Very Hot, Cold Days: Study
  43. Sleep Disorders May Have Roots in Brain Chemicals
  44. Premature Girls Have Better Growth Rate
  45. Possible Gene Found for Lou Gehrig's Disease
  46. Third Congenital Heart Defect Gene ID'd
  47. Children Hit by Migraines

    SUNDAY, JULY 6, 2003

  48. Ceramic Revolutionizes Hip-Replacement Surgery
  49. Third Congenital Heart Defect Gene ID'd
  50. Fight Foot Fungi.
  51. Keep Your Cool While Exercising in Summer Heat

    SATURDAY, JULY 5, 2003

  52. Stomach Surgery for the High School Set
  53. B-Vitamin Problems May Cause Depression in Some
  54. The Silent Killer
  55. Study Finds No Link Between Cooked Potatoes, Cancer

FRIDAY, JULY 11, 2003

Inflammation Linked to Cognitive Decline

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Friday, July 11, 2003

FRIDAY, July 11 (HealthDayNews) -- Inflammation in the body, measured by blood tests, is linked to cognitive decline in older adults, a team of researchers has found.

The new study, published in the July 8 issue of Neurology, adds weight to the hypothesis that inflammatory mechanisms in the body play a role in several age-related diseases, including Alzheimer's.

"There has been a lot of [medical] literature suggesting that inflammation may contribute to Alzheimer's disease and other disorders or aging," says study author Dr. Kristen Yaffe, an assistant professor of psychiatry, neurology and epidemiology at the University of California, San Francisco.

What was not known, she says, was which comes first -- the inflammation or the disease. "My idea was, OK, let's look at blood levels of inflammation. Those who start off with higher levels of the blood markers should have more cognitive decline [over time]. And that is indeed what we found," she says.

Yaffe and her co-researchers followed 3,031 black and white men and women, average age 74, who were enrolled in the ongoing Health, Aging and Body Composition Study. The scientists took blood levels of three known markers of inflammation, including interleukin-6 (IL-6), C-reactive protein and tumor necrosis factor. They repeated the tests two years later.

A battery of mental tests was also given to evaluate concentration, memory, language and other measures of cognitive functioning, both at the start and two years later.

After adjusting for age and other factors, they found that those who had the highest levels of inflammation -- whose blood levels of IL-6 and C-reactive protein were in the highest one-third -- had more cognitive decline compared to those whose blood levels of those substances were in the lower third.

If their IL-6 result was high, they were 34 percent more likely to have cognitive decline than those whose scores on the tests were in the lower third. If their C-reactive protein levels were in the top third, they were 41 percent more likely to have cognitive decline than those in the lower third.

Although those who suffered cognitive decline also had higher levels of tumor necrosis factor, the differences weren't statistically significant, Yaffe says.

While the next logical step -- which is already being studied -- is to determine if preventing inflammation with medication makes any difference, Yaffe says it's too soon to recommend taking drugs to ward off age-related cognitive decline.

And the study found no relationship between the use of anti-inflammatories and inflammation levels.

The study "is a very large, well-done study," says Bill Thies, vice president of medical and scientific affairs for the Alzheimer's Association. The finding "fits with the idea that excess inflammatory activities are somehow related to Alzheimer's."

"And it does suggest that some of these inflammatory markers might be useful" to identify those at high risk for developing cognitive problems, Thies adds.

But to date, Thies says, research looking at anti-inflammatory drugs shows more promise as a preventive option, rather than as a treatment.

Adds another expert, Dr. Joseph Quinn, a neurologist at the Portland (Oregon) VA Medical Center, "There are only two other studies that have suggested that inflammatory markers predict future cognition. And this one is different because it includes multiple markers of inflammation and includes large numbers of African-Americans."

"It is a very solid study," Quinn says. But he adds a caveat: "It is also important to note that these results do not mean that people should start taking anti-inflammatory medicines for the prevention of Alzheimer's."

More information

For more information on Alzheimer's disease, see the Alzheimer's Association. Read about how anti-inflammatories may protect against Alzheimer's disease.

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Skip Breakfast, Get Fat

Randy Dotinga
HealthDay Reporter
HealthDayNews 
Friday, July 11, 2003

FRIDAY, July 11 (HealthDayNews) -- It's a prime piece of conventional wisdom: Eat right before you go to bed and you'll get fat.

But new research suggests that late eaters are no more likely to be overweight than anyone else. It's what you consume the rest of the day -- especially in the morning -- that counts.

Americans who regularly skip breakfast are 4.5 times more likely to be fat, researchers found. But, in good news for the nibblers among us, those who eat four or more meals a day are actually on the thinner side.

"We tend to eat because of external cues instead of internal cues -- we eat until the plate's clean. If the plate has a lot less food on it, perhaps you'll be eating less," says Ruth Kava, director of nutrition with the American Council on Science and Health.

Researchers launched their study because experts don't fully understand how eating habits -- such as the timing and frequency of meals -- are tied to obesity, says study co-author Yunsheng Ma, an assistant professor of epidemiology at the University of Massachusetts Medical School.

The researchers examined a national cholesterol study that took place from 1994 to 1998. A total of 499 people reported five times a year on what they ate over 24 hours.

The findings of the study appear in the current issue of the American Journal of Epidemiology.

Ma and his colleagues found people who ate more than three times a day were about half as likely to be fat as those who ate three or fewer times a day. Ma suspects the difference may have something to do with fewer spikes in blood sugar levels among the frequent eaters.

Insulin levels go up when blood sugar rises, contributing to hunger and the buildup of fat, Ma says. Similar factors may be at work among those who frequently eat breakfast or dinner away from home, he says. The study found they were 4.5 times more likely to be fat.

Someone who eats breakfast at home might settle for a small, convenient meal, Kava says. "But if you go out, there's all kinds of tempting things like bacon and eggs and hash browns. Maybe you tend to indulge a little bit more. You don't have to do the work or clean up."

And what about the link between skipping breakfast and tipping the scales?

"You have not broken the fast soon enough to only need a moderate amount of calories," says Gail Frank, a professor of nutrition at California State University at Long Beach and a spokeswoman for the American Dietetic Association. "You are starving. How does the normal person respond? They eat, and they keep eating to compensate."

As for the study's rebuttal of the time-honored belief in the fattening properties of late-night meals, Ma says more research is needed to confirm that finding.

But it makes sense, Frank says, and counteracts the "myth" about the hazards of midnight munching.

The body continues digesting through the night, she says, even when people are asleep and not active. "The body doesn't know when the lights go off," she says.

More information

The American Dietetic Association offers plenty of resources about healthy eating. Or try the U.S. Centers for Disease Control and Prevention.

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New Insight into Graves Disease

Amanda Gardner
HealthDay Reporter
HealthDayNews
Friday, July 11, 2003

FRIDAY, July 11 (HealthDayNews) -- Scientists have long known that people suffering from Graves' disease have certain molecules that mistakenly attack their bodies, sending their thyroids into overdrive.

But for 40 years, no one has been able to identify these elusive molecules, known as autoantibodies. Now, in the July 12 issue of The Lancet, British researchers report they have finally managed to isolate the human monoclonal autoantibody that causes the thyroid to overproduce.

Although the molecule was isolated in only one patient, a 19-year-old man with Graves' disease, it could hold significant promise for the future diagnosis and treatment of the disease.

"Monoclonal" means that the antibodies come from one line of cells. "It's thought to be one rogue cell that then multiplies itself," says Donald Bergman, president of the American Association of Clinical Endocrinologists. "It means a single clone of cells that's gone awry is producing this antibody that's causing all this damage. It's a very, very exciting discovery."

Because only one cell line appears to be involved, researchers may be able to find extremely targeted treatments for the disease.

"The identification of this antibody and its availability to medical scientists represents a major step forward. Further studies will likely lead to a better understanding of Graves' disease," says Dr. Kenneth Hupart, chief of endocrinology, metabolism and diabetes at Nassau University Medical Center in East Meadow, N.Y. "More importantly, this report offers the promise of new therapies that may benefit patients with Graves' disease, the disfiguring eye problems that they can develop and can give rise to new approaches to caring for patients with thyroid cancer."

But Hupart also has a caveat. "These potential benefits will not be realized today or tomorrow, but they may help doctors lessen the burden of these thyroid diseases for patients in future years," he says.

The leading cause of hyperthyroidism, Graves' disease represents a basic defect in the immune system, causing production of antibodies that stimulate and attack the thyroid gland, causing growth of the gland and overproduction of thyroid hormone, according to the National Graves' Disease Foundation.

The disease comes about through a complicated process of reactions and counter-reactions. First, plasma cells in the body produce autoantibodies that attack the TSH (thyroid-stimulating hormone) receptor on the thyroid gland. In response, mirror-image antibodies are produced which stimulate the TSH receptor to neutralize the original autoantibodies. This causes the thyroid gland to overproduce thyroid hormone.

Graves' disease is unusual in this respect. "Most autoimmune processes are destructive. Either an antibody or an immune cell is programmed to destroy something," Bergman explains. "In Graves', that antibody is being produced to stimulate. It's mighty unusual."

But, if this is going to happen, it's just as well that it involves a monoclonal antibody, or just one cell line. This means that not all of the immune cells are being programmed to interfere with the thyroid gland, which in turn is good news when it comes to treatment possibilities.

"You certainly don't want to destroy the whole immune system," Bergman says. With this finding, it may be possible to devise an extremely targeted treatment which would affect only that one cell line and not the whole immune system.

Right now, treatment options for Graves' disease involve incapacitating or removing the thyroid gland. According to the National Graves' Disease Foundation, there are three standard methods of treatment. A patient might take drugs to inhibit the production of active thyroid hormone; he or she might take radioactive iodine to destroy part or all of the gland; or most of the gland could be surgically removed.

"Roughly half who take these drugs are cured," Bergman says. "Otherwise you have to destroy the thyroid or take it out. People who take synthetics [hormones] feel OK, but they don't feel quite like they did before because they lose the ability to make second-to-second adjustments. It's better than nothing."

More information

For more on Graves' disease, visit the National Graves' Disease Foundation or the American Thyroid Association.

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Is Inactivity Causing Diabetes among Kids?

HealthDayNews
Friday, July 11, 2003

FRIDAY, July 11 (HealthDayNews) -- Suspecting that inactivity is to blame for the skyrocketing rate of diabetes among children, a Georgia researcher plans to monitor and test third graders to find out for sure.

"Type 2 diabetes used to be called adult-onset diabetes because kids didn't get it," says Dr. Catherine Davis, an assistant professor of pediatrics at the Medical College of Georgia. "Now, kids are getting it in record numbers."

In fact, 10 times more kids have diabetes today than in 1990, she says.

Type 2 diabetes occurs when the body can't regulate blood glucose levels. Complications, which usually occur 20 years after diagnosis, affect many organs and can lead to heart attacks, stroke, kidney failure, pregnancy complications, blindness and poor blood circulation, which can require limb amputation.

In August, Davis will begin charting and testing 240 overweight third graders. For four months, one group will do 40 minutes of aerobic exercise daily, a second group will do 20 minutes of aerobic exercise, and a third group will not take part in the exercise. She plans to continue with different groups of children for three years, measuring the children's body composition and glucose tolerance before and after the exercise program.

Although high-fat diets probably contribute to the problem of overweight and diabetic kids, Davis says, a sedentary lifestyle may have more to do with it. People ate high-fat diets 100 years ago, she notes, but they had active lifestyles. Kids today sit in front of televisions and computers, rarely walk anywhere, and have fewer physical education classes at schools because of funding cutbacks.

More information

Here's where you can learn more about diabetes.

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Upper-Ear Piercing

HealthDayNews
Friday, July 11, 2003

(HealthDayNews) -- It may be a fashion statement, but is piercing your upper ear a safe thing to do?

According to the Mayo Clinic, it's a bad idea, primarily because an infection in the upper ear can quickly lead to cartilage damage and serious, permanent deformity of the ear.

While cartilage establishes the shape of your ear, it doesn't have its own blood supply. So if an infection does develop, antibiotics are often ineffective since there's no blood to transport the medication to the cartilage. This means that infected cartilage usually needs to be surgically removed.

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The Test Expectant Moms Shouldn't Skip

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Friday, July 11, 2003

FRIDAY, July 11 (HealthDayNews) -- When women visit Dr. William Frumovitz late in their pregnancy, they're probably thinking about bassinettes, baby clothes and breast-feeding.

So the California obstetrician makes it a point to tell them about a very important test they need between their 35th and 37th week of pregnancy -- one that will tell them whether they have a bacterium called Group B streptococcus, which can threaten the life of their newborn.

Also known as GBS, or Group B strep, it is the most common cause of sepsis and meningitis in newborns, according to the U.S. Centers for Disease Control and Prevention (CDC). Just last year, the CDC revised its 1996 guidelines for GBS testing and now recommends universal screening of all pregnant women at 35 to 37 weeks of pregnancy. In addition, the National Institutes of Health has declared July as National Group B Strep Awareness Month.

Before the screening guidelines were strengthened, about 8,000 infants in the United States got Group B strep every year, and one of every 20 infected babies died. Those who survive often have long-term problems with hearing, vision and learning.

Problems related to Group B strep, which usually is found around the vagina and rectum, can occur a few hours after birth. Sepsis, meningitis and pneumonia are the most common, the CDC says. But diseases related to Group B strep can also crop up months after birth.

In the past, Frumovitz says, doctors had a choice: Screen at 35 to 37 weeks of pregnancy and decide on a course of action based on the result, or follow a "risk-based" method. That meant identifying women who would be likely to need intravenous antibiotics during labor -- the treatment to prevent transmission -- by their individual risks. These could include delivery before 37 weeks or a fever just before labor.

Like most doctors, Frumovitz has switched to routine screening. The test itself is relatively inexpensive, about $25. And the benefits of catching the bacterium early are immense, says Frumovitz, who is also an assistant visiting professor at University of California Los Angeles' David Geffen School of Medicine.

While not all women who have the bacterium will pass it on to their babies, if they do it can be a life-threatening problem, he says. And treating it is fairly simple.

Awareness about the dangers of Group B strep for newborns is growing, says Dr. Laura Riley, an assistant professor of obstetrics and gynecology at Harvard Medical School who chairs the committee on obstetric practice for the American College of Obstetricians and Gynecologists. The college also now recommends universal screening of all pregnant women.

While many women have known about the dangers of Group B strep, Riley says, some may not be aware that the guidelines for detecting it have changed.

"Until last year, doctors could culture at 35 to 37 weeks and treat those with a positive culture, or not culture anyone and during labor if risk factors arose those women would get antibiotics," she says.

"Now, we culture all pregnant women between 35 and 37 weeks," says Riley, a specialist in infectious diseases. All women should expect their doctor to give them this test. If they don't, women are encouraged to ask about it.

Riley also tells pregnant women to follow up with their doctor about test results. Don't assume you're fine, she says. Be sure to get the results. Then, if they're positive, you will be advised about getting antibiotics during labor.

"The antibiotics a mom gets during labor decreases the Group B strep in the vagina and the amount the baby comes into contact with," Riley explains.

While the prospect of Group B strep sounds scary, Riley add, it's also important to put it in perspective.

"Twenty to 40 percent of pregnant women will have a positive culture. Of those, a teeny percentage will go on to have a baby who is infected," she says.

More information

For more on Group B strep screening, visit the American College of Obstetricians and Gynecologists. For information on Group B strep and newborns, check out the U.S. Centers for Disease Control and Prevention.

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Heart Failure Common in Pacemaker Patients

Reuters Health
Friday, July 11, 2003

NEW YORK (Reuters Health) - Patients who have a pacemaker often develop heart failure, British doctors have found. Sometimes, the patients are not aware of the problem.

Dr. Simon Thackray and colleagues at the University of Hull examined some 300 patients who were being seen for a routine pacemaker check-up. At that point, the patients had had a pacemaker for an average of 5 years.

The doctors found that 94 patients -- nearly a third -- had an improperly working left-heart chamber, a sign of heart failure. Of these patients, 83 had symptoms such as shortness of breath and fatigue, but the other 11 did not report any symptoms.

Heart failure was seen more often in patients with single-chamber pacemakers than in those with double-chamber pacemakers, Dr. Thackray's team reports in the European Heart Journal.

Patients who could walk only relatively short distances during a 6-minute test were more likely to have heart failure, as were those who had previously been diagnosed with coronary heart disease, and those who had been on pacing the longest time.

The physicians recommend that patients with pacemakers have regular echo tests to make sure impending heart failure is caught early and treated.

Source: European Heart Journal June 2003

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‘Watchful Waiting' Best for Infections in Newborns

Reuters Health
Friday, July 11, 2003

NEW YORK (Reuters Health) - The best way to combat a potentially serious newborn infection may be to just watch and wait, new research suggests.

Pregnant women who are infected with bacteria called Chlamydia trachomatis can pass the bug to their infant during birth, resulting in serious problems for the baby such as pneumonia. In the past, doctors gave the antibiotic erythromycin to all exposed infants to prevent infection.

Recently, however, this approach was stopped when studies showed that erythromycin may cause a serious stomach problem known as pyloric stenosis. A new approach, called watchful waiting, was recommended, in which only babies with infection symptoms received the drug.

In the new study, Dr. Marc B. Rosenman, from the Indiana University School of Medicine in Indianapolis, and colleagues used a special statistical program to compare the pros and cons of each approach in a hypothetical group of 100,000 newborns exposed to Chlamydia at birth.

The current findings are reported in the Archives of Pediatrics and Adolescent Medicine.

Giving erythromycin to all the infants, whether they had symptoms or not, would cost $28.3 million, almost twice the amount of watchful waiting approach, the researchers note.

Giving the drug to everyone would prevent nearly 6000 cases of pneumonia and over 1000 hospital admissions, but it would also result in 3284 cases of pyloric stenosis, the researchers found. This translates to one case of pyloric stenosis for every 30 infants who received erythromycin.

Still, there may be certain situations in which giving erythromycin to everyone is better than watchful waiting. For example, if more than 3.4 percent of the newborns were hospitalized with Chlamydia pneumonia, then giving everyone the drug was preferable to watchful waiting, the investigators point out.

The question of which approach is better could become moot if other drugs, such as azithromycin, can be shown to be safe and effective for preventing infection in exposed infants, they add.

Source: Archives Pediatrics and Adolescent Medicine June 2003

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Arthritis Outlook Worse for Women

By David Douglas
Reuters Health
Friday, July 11, 2003

NEW YORK (Reuters Health) - Both women and men with early rheumatoid arthritis improve rapidly with treatment, but ultimately women fare worse than men, new research from Sweden suggests.

Rheumatoid arthritis is a chronic disease that involves inflammation of the joints, resulting in pain and decreased mobility. The exact cause is unknown, but it is classified as an autoimmune disease--meaning that the patient's own body is actually attacking itself.

Drug therapy is effective at limiting joint damage in patients newly diagnosed with rheumatoid arthritis, Dr. Thomas Skogh told Reuters Health. Unfortunately, these patients still experience a decline in their functional abilities over time, he added.

In his study, men had joint disease that was equal to, if not worse than, that of women, Skogh noted. Still, men showed "signs of more pronounced improvement and a more favorable course than the women with regard to functional abilities," he said.

Skogh, from the University of Linkoping, and colleagues came to these conclusions after following 284 patients with early rheumatoid arthritis. The severity of their disease was gauged by a number of factors and a special questionnaire was given to the patients to determine their functional ability.

The new findings are reported in the Annals of the Rheumatic Diseases.

Disease severity improved in all patients during the first 3 months of treatment, but then it leveled off. At 1 year, the patients began to notice a drop in their functional abilities.

When the study began, men and women were equal in terms of functional ability. However, when they were tested again 1 and 2 years later, women had experienced a greater drop in their abilities than men.

"The reasons for this are not obvious," Skogh concluded, "but may reflect a more aggressive disease course in women."

Source: Annals of the Rheumatic Diseases July 2003

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U.S. Team Finds Hints of How, Why Cancer Spreads

By Maggie Fox
Health and Science Correspondent
Reuters Health
Friday, July 11, 2003

WASHINGTON (Reuters) - Researchers said on Friday they were starting to find clues left by cancer when it begins to spread, and hoped to develop them into tests that may save the lives of future patients.

They found several of the genetic and protein markers in the blood and tissue of patients whose cancer had killed them.

Some of those markers should serve as early tests for the spread, or metastasis, of cancer, they told a meeting of the American Association of Cancer Research.

If caught early enough, cancer is highly curable.

"People don't die because they got cancer. People die because they got cancer and we didn't detect it at a point where we could do something about it," Dr. Andrew von Eschenbach, head of the National Cancer Institute, told a news conference.

Metastasis is responsible for 90 percent of cancer deaths, according to the American Cancer Society.

Joan Massague, a Howard Hughes Medical Institute researcher at the Memorial Sloan-Kettering Cancer Center in New York, and colleagues have been making a painstaking search for the products used by cancer cells to spread.

The tumor cells must first travel around the body, find the bone, brain or other tissue they will invade and then literally break in. Each process will require different genes and proteins.

The research team started with tissue samples taken from a patient who died of breast cancer, but Massague said they were making similar findings in samples from other breast cancer patients as well as those with prostate cancer and melanoma.

First, they inoculated them into specially bred mice -- a standard first step in cancer research. The mice develop tumors made up of human cells, which can be studied.

They noted which genes were overactive in those tumors and then did a reverse test -- genetically engineering normal cells with those genes and seeing if they metastasized in mice.

Using that method, they identified 48 genes and their protein products that seem to help tumor cells spread, Massague said.

Some of them are "secretory products" -- proteins sent out by the cells, which can be measured in the blood.

One is MMP-1 or matrix metalloproteinase 1, an enzyme frequently targeted by cancer researchers.

It is used by cells to break open the collagen bonds that hold other cells together.

"We are finding in serum samples of patients with metastatic breast cancer that they have high levels of MMP-1," Massague said.

Another is interleukin-11, which is active in osteoclasts -- the cells that break down bone. "The tumor cell growing as it metastasizes in bone needs to eliminate the bone matrix in order to have room to grow," Massague said.

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Food May Trigger Life-Threatening Asthma

Megan Rauscher
Reuters Health
Friday, July 11, 2003

NEW YORK (Reuters Health) - For the first time, food allergy -- especially to peanuts -- has been shown to be a major cause of life-threatening asthma in children.

Asthma attacks are the most common reason for children to be hospitalized, say Dr. Graham Roberts from St. Mary's Hospital in London and a team of experts. Despite great strides in treatment, death due to childhood asthma has not dropped. Roughly 50 children in the U.K. and more than 200 in the U.S die each year from asthma.

Dr. Roberts' team studied 19 children who required emergency ventilator treatment for a life-threatening asthma attack, matching each patient to two other patients treated for a non-life-threatening asthma attack.

In the medical publication the Journal of Allergy and Clinical Immunology, they report that 53 percent of children with a life-threatening asthma attack were food allergic compared with only 10 percent of those who had asthma but did not require ventilation. Of those with known food allergy, most appeared to be to peanuts or other nuts.

Commenting on the findings, Dr. Hugh A. Sampson of Mount Sinai in New York said "perhaps some of the life-threatening asthma that we are seeing may in fact be related to food allergic reactions and have been misdiagnosed only as asthma."

He added, "This is particularly relevant to the inner-city population of the U.S.," which has a lot of illness due to asthma. "Really, at this point in time we have very little information about food allergy in this population."

Dr. Sampson hopes this paper "stimulates an awareness of the importance of food allergy" in connection with severe life-threatening asthma.

Source: Journal of Allergy and Clinical Immunology, July 2003.

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THURSDAY, JULY 10, 2003

New Hope for Peanut Allergy Sufferers

By Adam Marcus
HealthDay Reporter
HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- Children with mild peanut allergies have at least even odds they'll outgrow the problem, but a few who do may experience a rerun of the reactions.

So says a new study that followed 80 children with a history of peanut allergies, considered one of the most severe food reactions. Overall, the scientists say, between 20 percent and 25 percent of kids with peanut allergies will ultimately shed the affliction.

"It's better than we used to think," says research leader Dr. Robert Wood, a pediatrician and allergy expert at the Johns Hopkins Children's Center in Baltimore.

In a different study, Wood and his colleagues also found they can identify who is likely to outgrow their peanut allergy by looking at their immune system's reaction to small bits of peanut protein.

"It turns out that if you are reacting to a certain portion of the protein you have a far lesser chance of outgrowing it. But if it's a different part, you have a much better chance," Wood says.

Eventually, doctors could measure that reaction with a simple blood test. "The same is likely to be done with milk and egg allergies, where we're finding the same kinds of differences," he adds.

Dr. Hugh Sampson, an allergist at the Mount Sinai School of Medicine in New York City and a co-author of the peanut protein study, says such a test for peanuts could avoid up to 90 percent of future allergy tests to determine which children have outgrown the condition. These tests can provoke unpleasant and possibly dangerous reactions.

The studies appear in July issue of the Journal of Allergy and Clinical Immunology, which this month is devoted to peanut allergy research. Researchers held a press briefing Thursday to discuss the findings.

An estimated 1.5 million Americans are allergic to peanuts, and each year nearly 100 die after contact with them, according to the Food Allergy and Anaphylaxis Network. For some people, as little as 1/1,000th of a peanut can trigger a deadly reaction.

Until only recently, doctors believed peanut allergies were lifelong affairs. But a recent study by Wood's group showed that as many as 20 percent of toddlers allergic to peanuts grow tolerant to them by the time they enter school.

The latest study extends that work. Wood and his colleagues followed 80 children, aged 4 to 14, with a history of peanut allergy. All had blood levels of IgE -- the immune molecule that binds to peanut proteins -- of 5 kilounits per liter of blood, and many had much less of the antibody.

When tested again with a bit of peanut protein, 55 percent of the children passed the test, suffering no allergic reaction. That rate was even higher among those whose IgE levels were 2 kilounits or less.

Although 55 percent of children in the new study outgrew their allergy to peanuts, as many as three-quarters of those who reacted to the food have IgE levels above 5, Wood says. The study found that 23 percent of peanut allergy sufferers overall would lose their sensitivity with time.

"The incidence and prevalence of peanut allergy is increasing markedly," says Dr. Donald Leung, an allergy specialist at National Jewish Medical and Research Center in Denver. Peanut allergies account for roughly half of the 200-odd fatal food reactions in the United States each year, he adds.

While serious allergic reactions can be avoided with a prompt shot of epinephrine, eight in 10 people who die of food allergies never receive proper instruction in how to self-administer the injection, Leung says.

Researchers would like to prevent food allergies from occurring, rather than treat them in their throes. Sampson is helping lead an effort at Mount Sinai to create a peanut allergy vaccine, a gel-filled suppository that would activate a regulatory element of the immune system.

 

Work in rodents has been successful, he says, and the group hopes to test the vaccine in humans as early as next year.

More information

Check out the Food Allergy & Anaphylaxis Network or the American Academy of Allergy Asthma & Immunology.

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Surgery Not Needed for Many Brain Aneurysms

By Adam Marcus
HealthDay Reporter
HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- As scary as a looming brain aneurysm seems, most people who have one don't need emergency surgery, claims the largest study yet of how patients with the condition fare over time.

Indeed, the risk of operating on many unruptured aneurysms may outweigh the potential benefits, especially in older patients with relatively small artery defects, the study found.

"Most aneurysms in the general population don't rupture, but it's important to sort out which ones are more likely to," says Dr. David O. Wiebers, a neurologist at the Mayo Clinic and leader of the research, which appears in the July 12 issue of The Lancet. "In some cases, the risk is so low it's not advisable to do any procedure."

However, Wiebers adds, in patients for whom quick action is needed, doctors have ways of repairing aneurysms: "There are more options now than there ever have been before, and the technical quality is improving as time goes on."

According to the Brain Aneurysm Foundation, roughly 2 million Americans live with unruptured brain aneurysms -- areas of weakness in an artery wall that allow small balloon-like cul-de-sacs to form. Each year, 30,000 people in this country suffer ruptured aneurysms. Half die within minutes, while many of the rest either die soon after or face severe debilitation. Although unruptured aneurysms can cause headaches and other symptoms they often do not, lying in wait to be discovered on brain scans for other reasons, such as trauma or migraine headaches.

The latest study included 4,060 men and women with unruptured brain aneurysms who were seen at 61 clinics in the United States, Canada and Europe. Of those, 1,917 had surgery to repair the pouched vessels and 451 had small coils packed into the bulges to create clots and wall off the area. That left 1,692 patients whose aneurysms weren't repaired.

The patients were followed for as long as nine years, during which time 51 suffered a rupture. But the risk of a breach was minuscule -- almost 0 percent -- for people whose aneurysms were smaller than seven millimeters across. The rupture rate jumped to 3.3 percent for aneurysms between 7 millimeters and 12 millimeters wide, and to17 percent for those wider than that.

Several other factors also influenced the odds that an aneurysm would rupture. Aneurysms toward the back of the brain, though rarer, were more prone to breaking than those in the front. People with a previous history of a ruptured aneurysm in another site were more likely to have a break, too.

Older people weren't more likely than younger patients to have their aneurysms rupture, but they tended to do worse when operated on.

Patients who had coil implants did better in the short run than those who had surgery to clip off the bulging artery. Their risk of death or serious disability was 20 percent to 30 percent lower after a year.

"The thing that's not known is the long-term outcomes and durability of the coils," Wiebers says. "That's what we're hoping to do in the next phase of this." Average follow-up in the study ran four to five years, and the researchers hope to extend that to 10 years or so, he says.

Data from an earlier phase of the international study suggested that unruptured aneurysms smaller than about 10 millimeters didn't require repair. "The magical number was 10, now it's seven," says Dr. Jacques E. Dion, a brain surgeon at Emory University who is familiar with the new findings. "Is it going to hold there? I don't know."

Dr. Kieran Murphy, a neurosurgeon at Johns Hopkins University and an expert in coil therapy, agrees more evidence of their long-term effectiveness would be nice. "Always it's prudent to look at how much coil compaction takes place over time," Murphy says. Yet coil technology is advancing rapidly, he adds, and newer devices are designed to be more rugged than previous models.

Ultimately, Murphy says, the most important thing for patients is to get the option of surgery or coil implants -- and that often doesn't happen because coiling is still relatively uncommon.

More information

Try the Brain Aneurysm Foundation or the National Institute of Neurological Disorders and Stroke for more on aneurysms and their consequences.

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Get All the Facts on Breast Cancer Screening

HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- Women need better information about breast cancer screening to fully understand the potential benefits and risks, says an article in this week's British Medical Journal.

Breast cancer screening is common in many countries of the world, but there's ongoing debate about its value. There are wide variations in the estimates of the effectiveness of screening in preventing breast cancer deaths. Women are often given limited information in a language they may find difficult to understand, the article says.

Because of that, the potential harmful effects of breast cancer screening are often simply chalked up as the price worth paying for the perceived benefit.

Research into breast cancer screening programs should be done to develop flexible decision aids to provide women with balanced information.

The article says it's unacceptable that women undergoing breast cancer screening tests continue to suffer damage and regret because they didn't fully understand the potential harm.

More information

The American Cancer Society has updated breast cancer screening guidelines.

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Breakthrough for Muscular Dystrophy

Ed Edelson
HealthDay Reporter
HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- Italian scientists report a possible solution to a major problem plaguing researchers working on gene therapy for muscular dystrophy: how to get the right gene to the right place to stop the muscle-wasting process that cripples people with the condition.

A newly discovered kind of stem cell has successfully carried a corrective gene to muscles in mice with one form of muscular dystrophy, says a report in the July 11 issue of Science. The researchers are based at the Stem Cell Research Institute in Milan and the Institute of Cell Biology and Tissue Engineering in Rome.

It's much too early to think about human trials, says Sharon Hesterlee, director of research and development at the Muscular Dystrophy Association, but "this is a really significant piece of work. It's the first time we've been able to do a stem cell transplant and see an actual increase in function."

The researchers used a kind of cell they discovered only last year and have named mesoangioblasts. These cells are found in blood vessel walls and are stem cells, meaning they can transform themselves into a variety of other cell types -- blood, bone, muscle and connective tissue. Most important, the Italians have found, they can migrate into muscle cells around blood vessels, carrying genes with them.

In the newly reported experiments, the gene for alpha sarcoglycan, a protein whose mutation or absence causes a form of muscular dystrophy, was inserted into mesoangioblasts, which were then grown in cell cultures. The engineered cells were injected into the arteries of mice lacking the gene.

Three months later, the researchers found active alpha sarcoglycan proteins in the muscles of the treated mice, downstream from the injection site. The treated muscles contained a large number of apparently normal fibers, and the mice were able to walk on a rotating wheel longer than untreated animals -- although not as long as healthy mice.

"I'm convinced that this is an important result, but this is still not the therapy, for mice or for patients," says a statement by research leader Dr. Giulio Cossu.

For one thing, the mesoangioblasts used in the study were taken from fetal mice, which might cause serious problems for researchers in the United States, where strict limits have been put on fetal stem cell research.

The goal of the researchers is to extract mesoangioblasts from muscular dystrophy patients and inject them back into the same patients after the addition of the needed gene, avoiding an attack on the cells by the immune system.

Different genes would have to be used for the many varieties of muscular dystrophy, but Hesterlee sees no major problem. "We have lots of experience with many forms of muscular dystrophy already, with good mouse models," she says. But until now, efforts to implant the corrective genes using other cells or viruses have been disappointing, she adds.

An American laboratory made an important contribution to the research. "Our laboratory contributed the mice, reagents and technical advice," says Kevin P. Campbell, a professor of physiology and biostatistics at the University of Iowa College of Medicine. "They needed a well-characterized animal model of muscular dystrophy, and we have a very good model."

The Iowa laboratory now has replicated the Italian experiment and will continue to do work on the subject, Campbell says.

Decisions on what to do next can't be made until all researchers doing work on muscle regeneration get together, Hesterlee says. "We have a meeting of researchers in the next two weeks, and they will plan strategy," she says.

More information

You can get an overview of muscular dystrophy from the National Institute of Neurological Diseases and Stroke or the Muscular Dystrophy Association

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More Schooling Leads to Smarter Eating

HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- Your education level may influence how smart you are about eating a healthy diet.

A new study says Americans are eating healthier diets than they did in 1965, but college-educated people are eating healthier than high school dropouts.

That's a change from the 1960s, when college graduates, those who'd completed high school and people who hadn't finished high school all had about the same level of diet quality.

The current gap in diet between those with more education and those with less schooling may explain the large disparity in health between people in the higher and lower socioeconomic groups in the United States, researcher Barry Popkin, department of nutrition, University of North Carolina at Chapel Hill, says in a statement.

The study appears in the July issue of the American Journal of Preventive Medicine.

Popkin and his colleagues compared the dietary habits of 6,475 people in 1965 and 9,241 people in 1994-96.

In 1965, college-educated people consumed more calcium, iron and servings of fresh fruit than less-educated people. However, the college-educated group also ate more saturated fats. In 1994-96, people with a college education ate a much healthier diet than those with less schooling.

"In general, extra years of schooling related to small upward shifts in diet quality. The highest diet quality level was found among white women who attended college and for those with income far above the poverty line," Popkin says.

More information

Here's where you can learn more about nutrition.

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A Closer Look at Autism

HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- Early problems with simple face-to-face interaction may be responsible for the difficulties autistic children have in pointing and showing objects to other people, says new British research.

The results of the two-year study from the University of Durham could provide better understanding of the early language and communication problems found in children with autism.

"We have known for a long time that children with autism have special difficulties with pointing and showing objects to other people. Until recently, however, many researchers believed that this problem was due to the child's lack of awareness that people's thoughts and reactions were directed towards objects and events in the world around them," lead author Dr. Susan Leekam says in a statement.

"Our new research suggests a different interpretation -- that the failure to point and show things to others may emerge from much simpler beginnings of face-to-face interaction. These findings indicate that the problems may start even earlier in development than previously recognized," Leekam says.

The study included 20 pre-school children with autism and 20 developmentally delayed children in a comparison group. The two groups were matched for mental age.

The use of voice and touch by adults playing with the children was measured by a computer-based digital video analysis system. The system also measured the use of pointing and showing by the children.

Using this method, the researchers were able to examine in detail the effectiveness of touch or gaining a child's eye gaze and other methods of attention-seeking used by the adults.

The researchers found an autistic child's difficulty in responding to face-to-face interaction was strongly related to the problem of pointing and showing. Autistic children who did no pointing or showing objects to the adults were those most impaired in face-to-face interaction.

"This finding has implications for early intervention. Many parents are aware of difficulties long before a diagnosis of autism is made. By gaining greater understanding of these very early problems we hope that ways can be found to target them before other difficulties emerge," Leekam says.

More information

Here's where you can learn more about autism.

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New Treatment for Blood Clots

HealthDayNews
Thursday, July 10, 2003

THURSDAY, July 10 (HealthDayNews) -- A new method to combat blood clots may prevent bleeding in people who've had surgery or suffered a stroke.

That's the finding of a new study in the August issue of Nature Biotechnology.

This new approach involves attaching an anti-clotting agent called tissue plasminogen activator to the surface of red blood cells. That prolongs the life of the clot buster in the blood and targets the newly forming blood clots that are most lethal to patients.

Most treatments to dissolve blood clots have only a short lifespan in the blood and can cause bleeding and serious brain injuries by indiscriminately attacking clots around the body.

Researchers at the University of Pennsylvania Medical School tested the new method's ability to dissolve clots in mice and rats. They found the new anti-clotting agent was more stable in circulation and avoided the problems of diffusion from blood vessels, which can cause harmful bleeding.

The study concluded that coating a patient's red blood cells with the anticlotting agent could prevent many clot-related deaths that can't be prevented using current therapies.

More information

Here's where you can learn more about blood clots.

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Air Sick?

HealthDayNews
Thursday, July 10, 2003

(HealthDayNews) -- Are you plagued by motion sickness whenever you take a plane trip?

The Aerospace Medical Association offers this advice:

  • When you check in, ask for a seat over the wing.
  • Book your flights on larger airplanes.
  • Request a window seat.
  • Avoid alcohol for the 24 hours before you fly and during the journey.
  • Keep your seatbelt fastened.
  • If necessary, before you fly, ask your doctor about motion sickness medication.

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Deep-Vein Thrombosis

HealthDayNews
Thursday, July 10, 2003

(HealthDayNews) -- When the legs are confined to one position for any length of time, whether due to work, travel or illness, your risk of deep-vein thrombosis (DVT) increases. It's a condition caused by a blood clot developing in the leg veins.

The Johns Hopkins Health After 50 newsletter suggests these measures for decreasing your risk of DVT:

  • Maintain a healthy lifestyle that includes achieving a healthy weight, not smoking, and exercising regularly.
  • Whenever your movement is restricted, try to flex your ankles and move your legs frequently.
  • When you sit or lie down, elevate your legs using a stool and pillows.
  • Wear clothing that doesn't constrict blood flow.

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FDA Orders Revised Epilepsy Drug Warning

The Associated Press
Thursday, July 10, 2003

WASHINGTON - The government has ordered more detailed information to be provided with an epilepsy drug that did not warn about decreased sweating and hyperthermia.

The order for updated information on Topamax is based on clinical trials and the experience of more than 2 million users worldwide, the Food and Drug Administration said Thursday.

Most of the reports of problems have involved children. Most cases have occurred in connection with exposure to hot temperatures, vigorous activity or both. Children using the medication should be closely observed under these conditions, the FDA said.

The FDA said potential cases of decreased sweating were observed in about 35 per 1 million Topamax patients; 1.6 users per 1 million had serious problems with it.

On the Net:

Food and Drug Administration: http://www.fda.gov

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New Blood Test May Help With MS Diagnosis

Linda A. Johnson
Associated Press Writer
The Associated Press
Thursday, July 10, 2003

Scientists have developed a blood test that appears to be the first reliable way to predict whether patients with neurological problems such as tingling or blurred vision will soon develop the debilitating disease multiple sclerosis.

Austrian researchers studying patients with possible MS symptoms found that those with two kinds of antibodies in their blood early on were 76 times more likely to develop the tough-to-diagnose disorder than those with neither antibody.

Some of the potential early symptoms of MS can have numerous other causes, such as a stroke or a brain tumor. Moreover, one-third of patients with these initial symptoms recover and never develop MS; others can go for years before they have a second flare-up showing they have MS.

Up to now, "nobody was able to predict for an individual patient what will be in the future," said lead researcher Dr. Thomas Berger of the department of neurology at University of Innsbruck.

MS is incurable. But Berger said the blood test could help doctors decide whether to offer a patient early treatment with drugs recently proven to reduce flare-ups and slow the progression of the disease in some people.

The best current diagnostic test, an MRI scan for lesions on nerves in the brain and spinal cord, can only predict the chances of developing multiple sclerosis over the next decade, and its accuracy ranges from 80 percent down to 11 percent, Berger said. The blood test is 95 percent accurate in predicting which people will have a flare-up within several months, he said.

"These antibodies seem to predict the next attack and therefore a diagnosis of MS," said Dr. Stuart Cook, a neurologist and president of the University of Medicine and Dentistry of New Jersey. "I think it's an important contribution."

About 400,000 Americans, mostly women, have multiple sclerosis, which usually strikes between age 20 and 40.

MS is poorly understood but involves damage to nerve fibers and their protective myelin sheath in the brain, spinal cord and eyes. The cause is unknown, but doctors suspect a virus or other infection makes the immune system attack the myelin and nerve fibers.

Symptoms include weakness, tremors, difficulty walking, blindness, incontinence and emotional problems.

The disease can lie dormant for months or years, then worsen steadily or cause repeated flare-ups. Some victims become disabled; others lead fairly normal lives.

Often, MS is not diagnosed until the second episode of symptoms. Many doctors just monitor patients until then, rather than starting treatment, because the initial symptoms often are not due to MS at all; because medications do not work for some people and have serious side effects; and because MRIs, even when combined with spinal fluid tests and patient history, can be inaccurate.

In the Austrian study, reported in Thursday's New England Journal of Medicine, doctors tested 103 patients with possible early symptoms for their levels of antibodies called anti-MOG and anti-MBP; MRI scans were used to determine how many nerve lesions they had.

After repeated testing for about four years on average, the doctors found only 23 percent of patients with neither antibody had a relapse, after 3 3/4 years on average. Among those with both antibodies, 95 percent had such a disease-defining relapse, within just 7 1/2 months on average. Among those with just anti-MOG protein, 83 percent had a relapse, on average within 14 1/2 months.

The results must be confirmed, among more patients and with a longer follow-up, Cook said.

He and Berger both said that the study does not prove whether the antibodies cause the nerve damage, or are a response to it.

Cook noted that unlike the lesions spotted by MRI scans, the antibodies did not help predict the eventual severity of the disease.

In an accompanying editorial, Drs. Jack P. Antel and Amit Bar-Or of the Montreal Neurological Institute said the findings, once confirmed, could identify subgroups of patients that particular drugs would help the most. Choosing the right drug now is hit-or-miss.

On the Net:

New England Journal: http://www.nejm.org

Multiple Sclerosis Foundation: http://www.msfacts.org

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FDA Loosens Food Label Requirements

Lauran Neergaard
AP Medical Writer
The Associated Press
Thursday, July 10, 2003

WASHINGTON - The government is loosening restrictions on how much scientific proof is required to advertise a food's possible health benefits on its package, a move welcomed by food makers but one that critics fear will leave consumers prey to quackery in the grocery aisles.

The Food and Drug Administration announced Thursday that it will accept applications to place "qualified" health claims on food labels beginning Sept. 1. Among the first to be considered: that eating several servings a week of salmon and certain other fish rich in omega-3 fatty acids is thought to, but not proved to, reduce the risk of heart disease.

"We want to help increase America's nutritional grade-point average," said FDA Commissioner Mark McClellan. "Americans shouldn't need a science degree to figure out how foods can fit into a healthy diet. Information should be accurate, honest and easy to understand."

Until now, the FDA has enforced a very strict standard about what health claims could be made on food labels. Before oatmeal could boast heart-healthy labels, for example, there had to be significant scientific consensus that oatmeal's fiber helps maintain low cholesterol levels.

Under the new program — backed by food manufacturers — FDA will give a grade to applications for new food claims: A for scientifically proven claims; B where the science is good but not conclusive; C when there's limited science to support a claim; and D when there's hardly any.

A-rated claims — such as "calcium prevents bone-weakening osteoporosis" — are the kind already permitted, and won't change.

Claims rated a "B, "C," or "D" would be considered qualified, and for the first time could be put on a food label right next to a short disclaimer that describes the level of proof. Whether the letter grade itself also will go on packages is still under consideration.

A congressman influential in passing a decade-old law that governs food labeling said the FDA is essentially violating that law.

"FDA's decision is going to permit virtually unsupported health claims on foods," said Rep. Henry Waxman, D-Calif. "When consumers see a claim on a product and later learn it was a false claim, they're going to decide perhaps none of the labels on those food products mean anything."

At best, it means wishy-washy health advice will suddenly appear on foods, confusing consumers, said Bruce Silverglade of the consumer advocacy group Center for Science in the Public Interest

"This action represents the biggest rollback in food-labeling standards in 20 years," said Silverglade. His group is talking with Waxman about a possible legal challenge.

The Grocery Manufacturers of America says low-rated claims make sense in the wake of recent court rulings that allow more loosely regulated dietary supplements to make more far-reaching claims about health effects.

The influential Consumer Federation of America agrees that the court pressure is real, and says the FDA's new program would probably safeguard against abuse.

The budget-stretched FDA will give priority to a number of claims expected to win a good B-rating: The omega-3's heart benefit; that products made with vegetable oils are more heart-healthy than those made with solid fats; that substituting nuts for other fatty proteins also is heart-healthy. Various health groups, such as the American Heart Association, already make some of those recommendations.

Other examples — some controversial — the food industry expects to seek: That the antioxidant lycopene, rich in cooked tomato products, can prevent prostate cancer; that lowfat dairy products lower blood pressure; that fiber prevents colon cancer; that compounds in grapes are heart-healthy.

McClellan thinks few manufacturers would bother advertising low-rated claims, instead doing better research or making a product healthier.

"You'd have to do a lot better than a 'C' to attract consumers to your product," he said. "Good nutrition should also be good business."

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'WEDNESDAY, JULY 9, 2003

Child-Friendly Drug Repellant

HealthDayNews
Wednesday, July 09, 2003

(HealthDayNews) -- When your kids head outdoors, it's advisable to apply insect repellant to ward off any disease-carrying mosquitoes.

According to the U.S. Centers for Disease Control and Prevention (news - web sites), most guidelines say it's okay to use products containing DEET on kids over age two.

Here are some pointers when using repellant on your child:

  • Apply it first to your own hands and then rub them on your child.
  • Don't apply it to your child's hands; they tend to put their fingers in their mouths.
  • Don't allow your child to self-apply repellant.
  • Don't rub it on the skin under your child's clothing. And wash clothing that's been treated with repellant before it's worn again.

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Group Targets Stroke Death Rate in South

Murray Evans
Associated Press Writer
The Associated Press
Wednesday, July 09, 2003

LEXINGTON, Ky. - A national group is trying to get family doctors to talk about stroke risk factors and prevention more with patients in the South, which has the some of the highest stroke death rates in the country.

The National Stroke Association launched its campaign in Kentucky on Tuesday and has sent letters to all family care doctors in the state. The group will focus initially on the so-called "Stroke Belt," 12 states, mostly in the South, in which stroke death rates are consistently more than 10 percent higher than the rest of the country.

Doctors suspect the South has a higher stroke death rate because it has more poor communities with less access to health care and greater risk factors such as obesity, smoking and lack of physical activity.

Kay Wan, a spokeswoman for the National Stroke Association, said about 50 percent of Americans cannot recognize even one stroke symptom, and that family doctors are on the front line of seeing people at risk.

"We felt there was a huge need to reach out ... and ask them to talk about stroke with their patients a little bit more," she said.

Strokes affect 700,000 Americans every year, and 165,000 of them die as a result. A stroke occurs when a blood clot blocks the blood flow in a vessel or artery or when a blood vessel breaks, interrupting blood flow to an area of the brain.

Symptoms include sudden blurred or decreased vision, loss of balance or coordination, difficulty speaking or understanding simple statements and numbness or paralysis in the face, arm or leg.

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Heart Disease, Not Always a Death Sentence

HealthDayReporter
Wednesday, July 9, 2003

WEDNESDAY, July 9 (HealthDayNews) -- A gene called macrophage scavenger receptor 1 (MSR1) plays an important role in the development of prostate cancer in black American men.

So says a study in the July 1 issue of Cancer Research.

The finding comes from a larger project called the Flint Men's Health Study, which is meant to identify prostate cancer risk factors in black American men.

"African-American men have the highest incidence of prostate cancer in the world. The severity is higher and they tend to die more quickly after diagnosis," study author Dr. Kathleen Cooney, an associate professor of internal medicine at the University of Michigan Comprehensive Cancer Center, says in a statement.

"We don't know why this is, but part of the difficulty is that African-American men are underrepresented in most genetics studies," Cooney says.

This study included black men, aged 40 to 79, living in Flint, Mich. DNA samples were collected from 134 men diagnosed with prostate cancer and 340 men without the disease. After analyzing the DNA samples, the researchers concluded that rare germ-line MSR1 mutations were associated with an increased risk of prostate cancer.

Previous studies found the same association in white men.

"This study adds to an expanding body of evidence in support of germ-line MSR1 mutations as risk factors for prostate cancer. Although our study was modest in size, the public health burden of prostate cancer in the African-American community warrants further attention to potential genetic risk factors," lead author Dr. David Miller, a urology resident at the University of Michigan Medical School, says in a news release.

More information

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

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Anti-Malaria Pill Comes with Risk Guide

The Associated Press
Wednesday, July 09, 2003

WASHINGTON - People prescribed Lariam to prevent malaria before a trip abroad will now get a government-ordered brochure along with the pills describing what to do if some rare but serious side effects strike.

The FDA announced Wednesday that every Lariam prescription now will come with a medication guide that explains its pros and cons in consumer-friendly language.

The new warnings stress that some people shouldn't take the drug: those with active or recent depression, a history of other psychiatric disorders, or epilepsy.

The guide also advises patients who suddenly experience psychiatric side effects to promptly contact a doctor — they may need to stop the Lariam and switch to another anti-malaria pill.

Last year, the FDA strengthened warnings on the drug's label that it can cause some rare but potentially serious psychiatric side effects, ranging from anxiety and dreams to hallucinations, depression, occasionally even psychotic behavior.

FDA's Dr. Leonard Sacks said the new guide addresses concerns that the information was still not reaching those who need it. About 800 Americans a year return home infected with malaria, most because they didn't know to take the pills or skipped them from worry about side effects.

Most of the several million Americans who travel to malaria-plagued countries come home healthy thanks to one of several protective drugs. Lariam is the most prescribed among them.

The guide will not imply that Lariam is a worse choice than other anti-malaria pills, Sacks said. Each has side effects, and Lariam has advantages that make it an important option.

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Drug Cuts Blood Clot Risk in Cancer Patients

HealthDayNews
Wednesday, July 09, 2003

WEDNESDAY, July 9 (HealthDayNews) -- The potentially fatal blood clots that plague many cancer patients are better treated with an injectable heparin drug than with an oral blood-thinning agent, a major international study finds.

This is a straightforward medical finding, yet the potential difficulty of putting it into clinical practice illustrates how financial considerations can influence medical decisions, says a physician who took part in the study.

In the study, only 27 of the 336 patients who used self-injected dalteparin, a sophisticated low-weight heparin, had recurrences after their first clot, compared to 53 of the 336 patients who were given coumarin, a standard oral drug, says a report in the July 10 issue of the New England Journal of Medicine (news - web sites).

Other studies have shown similar results, says Dr. Steven R. Deitcher, head of the section of hematology and coagulation medicine at the Cleveland Clinic. He has done one of those studies, which used another low-weight heparin, enoxaparin.

While Deitcher cannot give detailed results of his study because it has not yet been published in a medical journal, he says those findings are in general agreement with those of the newly published study.

Yet doctors continue to use coumarin, in large part for monetary reasons, he says. Dose for dose, a low-weight heparin costs at least 10 times more than coumarin, and Medicare does not pay for it.

It's an important issue, Deitcher says: "Cancer patients are in a very high-risk group with regards to development of blood clots, because of the underlying disease as well as many treatments."

To give just one example, the catheters that are implanted to administer drugs increase the risk of clots. "Some feel that thrombosis [clotting] is one of the most proximate causes of death in cases of solid tumors," Deitcher says.

Coumarin is a notoriously difficult drug to manage. Blood levels must be kept in a narrow range, yet they can swing erratically, especially in cancer patients. Those patients must have frequent blood tests, and they often must be hospitalized.

Avoiding those problems makes low-weight heparin "comparable in terms of cost- effectiveness," says study author Dr. Mark N. Levine, professor of medicine and clinical epidemiology and biostatistics at McMaster University in Canada.

"When you consider not only the cost of the drug but also the cost of downstream events avoided, it's a wash," he says.

Levine says he believes doctors treating cancer patients for blood clots will "undoubtedly" switch to low-weight heparin, now that they can cite the results of this study. The switch will not come quickly, but it is under way, he says.

"People now have to go through the appropriate regulatory approvals, but the first step is to prove the science," Levine says.

More information

You can learn the language of thrombosis from the American Heart Association. Read about other complications from cancer from the National Cancer Institute.

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Chromosome Linked to Deafness, Lymphomas Sequenced

Patricia Reaney
Reuters Health
Wednesday, July 09, 2003

LONDON (Reuters) - Scientists have finished sequencing human chromosome 7, which contains genes linked to hand and facial development, cystic fibrosis, deafness, lymphoma and other cancers.

It is the sixth and largest chromosome to be sequenced so far and contains 153 million letters of DNA and about 1,150 genes, including one which may help to explain why cancer cells are resistant to some drugs, and others that are involved in the body's immune response.

"This is another volume in the encyclopedia that is research ready. There are a number of genes that are involved in human cancers that are going to give us a good understanding of what goes on in the genomes of people that have these types of cancer," Dr. Richard Wilson, the director of Washington University's Genome Sequencing Center in St. Louis, Missouri, said in an interview.

"It gives us a leg up on designing new therapeutics that will help us treat them," he added.

Scientists from several centers in the United States and Germany completed the sequence, which is reported in the latest edition of the science journal Nature.

In addition to the gene for cystic fibrosis, chromosome 7 also contains several genes for Williams-Beuren syndrome (WBS), a rare disorder that causes unusual facial appearance and mild mental retardation.

"I think it will help us understand some of the genetic components of head and face development. There are a number of genes for that. There are also a number of genes involved in various types of white blood cell cancers, lymphoma and leukemia," Wilson added.

The finished sequence, which is freely available on the Internet, provides a treasure chest of information for scientists studying those diseases.

It will allow scientists to look at people who have these diseases to understand the underlying genetics and to develop treatments, such as the leukemia drug Glivec, which are aimed at gene products.

"If we can correlate other genes on chromosome 7 with some of these lymphomas and leukemias it may be possible to design drugs that go right after those types of (gene) products," Wilson added.

Each chromosome is made up of a molecule of DNA in the shape of a double helix which is composed of four chemical bases represented by the letters A (adenine), T (thymine), G (guanine) and C (cytosine). The arrangement, or sequence, of the letters determines the cell's genetic code.

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New Blood Test May Help with MS Diagnosis

Linda A. Johnson
Associated Press Writer
The Associated Press
Wednesday, July 09, 2003

Scientists have developed a blood test that appears to be the first reliable way to predict whether patients with neurological problems such as tingling or blurred vision will soon develop the debilitating disease multiple sclerosis.

Austrian researchers studying patients with possible MS symptoms found that those with two kinds of antibodies in their blood early on were 76 times more likely to develop the tough-to-diagnose disorder than those with neither antibody.

Some of the potential early symptoms of MS can have numerous other causes, such as a stroke or a brain tumor. Moreover, one-third of patients with these initial symptoms recover and never develop MS; others can go for years before they have a second flare-up showing they have MS.

Up to now, "nobody was able to predict for an individual patient what will be in the future," said lead researcher Dr. Thomas Berger of the department of neurology at University of Innsbruck.

MS is incurable. But Berger said the blood test could help doctors decide whether to offer a patient early treatment with drugs recently proven to reduce flare-ups and slow the progression of the disease in some people.

The best current diagnostic test, an MRI scan for lesions on nerves in the brain and spinal cord, can only predict the chances of developing multiple sclerosis over the next decade, and its accuracy ranges from 80 percent down to 11 percent, Berger said. The blood test is 95 percent accurate in predicting which people will have a flare-up within several months, he said.

"These antibodies seem to predict the next attack and therefore a diagnosis of MS," said Dr. Stuart Cook, a neurologist and president of the University of Medicine and Dentistry of New Jersey. "I think it's an important contribution."

About 400,000 Americans, mostly women, have multiple sclerosis, which usually strikes between age 20 and 40.

MS is poorly understood but involves damage to nerve fibers and their protective myelin sheath in the brain, spinal cord and eyes. The cause is unknown, but doctors suspect a virus or other infection makes the immune system attack the myelin and nerve fibers.

Symptoms include weakness, tremors, difficulty walking, blindness, incontinence and emotional problems.

The disease can lie dormant for months or years, then worsen steadily or cause repeated flare-ups. Some victims become disabled; others lead fairly normal lives.

Often, MS is not diagnosed until the second episode of symptoms. Many doctors just monitor patients until then, rather than starting treatment, because the initial symptoms often are not due to MS at all; because medications do not work for some people and have serious side effects; and because MRIs, even when combined with spinal fluid tests and patient history, can be inaccurate.

In the Austrian study, reported in Thursday's New England Journal of Medicine, doctors tested 103 patients with possible early symptoms for their levels of antibodies called anti-MOG and anti-MBP; MRI scans were used to determine how many nerve lesions they had.

After repeated testing for about four years on average, the doctors found only 23 percent of patients with neither antibody had a relapse, after 3 3/4 years on average. Among those with both antibodies, 95 percent had such a disease-defining relapse, within just 7 1/2 months on average. Among those with just anti-MOG protein, 83 percent had a relapse, on average within 14 1/2 months.

The results must be confirmed, among more patients and with a longer follow-up, Cook said.

He and Berger both said that the study does not prove whether the antibodies cause the nerve damage, or are a response to it.

Cook noted that unlike the lesions spotted by MRI scans, the antibodies did not help predict the eventual severity of the disease.

In an accompanying editorial, Drs. Jack P. Antel and Amit Bar-Or of the Montreal Neurological Institute said the findings, once confirmed, could identify subgroups of patients that particular drugs would help the most. Choosing the right drug now is hit-or-miss.

On the Net:

New England Journal: http://www.nejm.org

Multiple Sclerosis Foundation: http://www.msfacts.org

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Bad Gene Ups Prostate Cancer Risk in Black Men

HealthDayNews
Wednesday, July 09, 2003

WEDNESDAY, July 9 (HealthDayNews) -- A gene called macrophage scavenger receptor 1 (MSR1) plays an important role in the development of prostate cancer in black American men.

So says a study in the July 1 issue of Cancer Research.

The finding comes from a larger project called the Flint Men's Health Study, which is meant to identify prostate cancer risk factors in black American men.

"African-American men have the highest incidence of prostate cancer in the world. The severity is higher and they tend to die more quickly after diagnosis," study author Dr. Kathleen Cooney, an associate professor of internal medicine at the University of Michigan Comprehensive Cancer Center, says in a statement.

"We don't know why this is, but part of the difficulty is that African-American men are underrepresented in most genetics studies," Cooney says.

This study included black men, aged 40 to 79, living in Flint, Mich. DNA samples were collected from 134 men diagnosed with prostate cancer and 340 men without the disease. After analyzing the DNA samples, the researchers concluded that rare germ-line MSR1 mutations were associated with an increased risk of prostate cancer.

Previous studies found the same association in white men.

"This study adds to an expanding body of evidence in support of germ-line MSR1 mutations as risk factors for prostate cancer. Although our study was modest in size, the public health burden of prostate cancer in the African-American community warrants further attention to potential genetic risk factors," lead author Dr. David Miller, a urology resident at the University of Michigan Medical School, says in a news release.

More information

Here's where you can learn more about prostate cancer

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Government Requires Trans-Fat Labels on Food

Maggie Fox
Reuters Health
Wednesday, July 09, 2003

WASHINGTON (Reuters) - All packaged foods sold across America will have to carry labels telling people how much artery-clogging trans-fats they contain under new U.S. government regulations issued on Wednesday.

Trans-fatty acids are a component of fat and are found in all animal fats, from meat to butter. They are also made synthetically when food processors harden fat to make it more like butter in a process called hydrogenization.

Found in meat, milk, cookies and fries, trans-fats raise cholesterol, especially "bad" or LDL cholesterol.

"Trans-fats are bad fats. The less trans-fat you and I eat, the healthier we will be," Health and Human Services Secretary Tommy Thompson told a news conference.

He promised more regulation regarding nutrition claims and labeling. "This is just the beginning of a lot more rules and regulations about this. We are moving now very rapidly," Thompson said.

While food labels warn consumers about saturated fats, which also raise cholesterol, there is currently no way to know for sure whether a food contains trans-fats.

The new requirement, which takes effect as of January 2006, comes a year after government advisers at the Institute of Medicine recommended it. It was first proposed in 1999 but HHS and the Food and Drug Administration re-opened the comment period twice.

"Trans-fats can no longer lurk, hidden, in our food choices," said Food and Drug Administration commissioner Dr. Mark McClellan.

GROUPS WELCOME NEW MOVE

The Center for Science in the Public Interest, which has been pressing for labels, said the move "will spur companies to reformulate products and to let consumers know how much of this dangerous and heretofore hidden fat is in packaged foods."

"It will be hard, though, for people to tell if a given number of grams of trans-fat is a lot or a little. Five grams may not seem like a lot, but it is," CSPI nutrition policy director Margo Wootan said in a statement.

McClellan said his agency had no scientific findings to use in recommending a set level of trans-fats in the diet. People should simply aim to eat as little as possible, he said, and should look for words such as "saturated" and "hydrogenated" on labels.

The rule does not apply to restaurants but Thompson said he had also been talking to the restaurant industry. "People all over the industry are beginning to recognize the problem of obesity and overweight Americans," Thompson said.

Manufacturers have already begun making foods without trans-fats, including some soft margarines, cookies, crackers and other products.

"Modern margarine products are significantly reduced in trans-fat as well as overall fat and saturated fat," Keith Keeney, vice president of the National Association of Margarine Manufacturers, said in a statement.

The National Food Processors Association said it was happy with the new requirement.

"This rule's effective date of 2006 will enable food companies to undertake the substantial process of redesigning and relabeling their products within a workable timeframe." Dr. Rhona Applebaum, executive vice president of the NFPA, said in a statement.

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MONDAY, JULY 7, 2003

Macular Degeneration

HealthDay Reporter
Monday, July 07, 2003

(HealthDayNews) -- Macular degeneration, a leading cause of blindness in people over age 55, affects millions of Americans, according to the American Macular Degeneration Foundation.

Here are some ways you can reduce your risk of developing the disorder:

  • Eat lots of dark green, leafy vegetables rich in carotenoids, especially spinach and collard greens.
  • Protect your eyes from potentially harmful ultra-violet and blue light.
  • Antioxidant vitamins and zinc supplements may help.
  • Don't smoke.
  • Eat a low-fat diet, and avoid junk food.
  • Exercise regularly

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Is It Anorexia Nervosa?

HealthDay Reporter
Monday, July 07, 2003

(HealthDayNews) -- If your child is skipping meals and getting thinner by the day, how can you tell whether anorexia nervosa is the cause?

Boys Town Pediatrics in Omaha, Nebraska, offers these warning signs:

  • She's lost weight rapidly.
  • She feels faint when she stands up too fast.
  • She has irregular or non-existent menstrual periods.
  • She always complains that she's cold. This is from a loss of body fat.
  • She looks unusually pale.
  • Her nails and hair have become brittle.
  • She's constipated.

If you suspect your child may fit the profile, discuss your concerns with her doctor.

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Urinary Tract Infection Germ Impervious

By Paul Recer
AP Science Writer
The Associated Press
Monday, July 07, 2003

WASHINGTON - A germ that causes stubborn urinary tract infections may be resistant to antibiotics because it invades the bladder cells and builds a fort-like colony that is impervious to drugs and attack from the body's own immune system, researchers say.

In a study appearing Friday in the journal Science, scientists at Washington University in St. Louis report using an electron microscope to discover that E. coli bacteria form a biofilm inside cells of the bladder cells of mice.

This biofilm is composed of bacteria unified into a colony to resist attack, said Dr. Joseph J. Palermo, a Washington University researcher and a co-author of the study.

"The bacteria rest in a matrix like eggs in a carton," said Palermo. He said this is the first time that a biofilm structure has been found within a cell, and the discovery explains why many patients are unable to ever become completely free of urinary tract infections.

"In a biofilm, thousands and thousands of bacteria work together as sort of a multicellular organism," said Gregory G. Anderson, a co-author of the study.

Anderson said the biofilm "is a slimy type of mesh" similar to the slick coating often found on submerged rocks in a stream or pool of water.

Although the study was of mouse bladders, Palermo said the animal is a commonly studied model for urinary tract disease because the tissue, cells and infection response of the rodent bladder are very similar to that of humans.

Dr. Josephine P. Briggs, head of group studying urinary tract disease at the National Institute of Diabetes and Kidney Research, one of the National Institutes of Health, said the discovery of an E. coli biofilm is "very intriguing." She said it explains why some bladder infections are so difficult to control in some patients.

"This study demonstrates this in mice, but there is no reason to think the process is not occurring in people," said Briggs. "That needs to be documented, but it is very likely."

If biofilm formation is confirmed in humans, she said, then it adds a new sense of urgency to the need to develop alternate ways to treat stubborn urinary tract infections.

The Washington University researchers said their studies show that individual E. coli bacteria assume different roles within the biofilm, acting like members of a multi-cell organism. Bacteria on the edge of the biofilm can burst out of the host cell and colonize other cells within the bladder wall.

Because the bacteria are within the cells of the bladder, they often are not detected by routine medical tests, said Palermo.

"When you check a urine sample for the presence of bacteria, all you are looking for are free floating bacteria," he said. "If there are bacteria in the bladder tissue itself, you are not going to pick them up. Having sterile urine doesn't really give you a picture of what the bacteria state of the bladder is. It makes diagnosis more difficult."

Recurring or highly resistant urinary tract infections are a major medical problem, particularly among women. The infections cause frequent and painful urination, fever and can lead to more dangerous kidney infections.

About 8 million urinary tract infections are diagnosed annually, second only to respiratory infections in the United States.

Antibiotics usually knock out the infections, but for many it becomes a problem returning time after time.

On the Net:

Science: http://www.sciencemag.org/

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Chilling Heart Patients Saves Their Brains: Study

Reuters Health
Monday, July 7, 2003

WASHINGTON (Reuters) - Putting patients on ice after they suffer cardiac arrest helps to prevent brain damage caused by the drop in blood circulation, an international team of researchers reported on Monday.

Cardiac arrest -- the trembling heart malfunction that can be reversed using a defibrillator -- can not only kill but it can leave a survivor with dead brain cells.

Two studies published in the journal Circulation show that cooling the body temperature to below the normal 98.6 degrees F can help prevent that damage.

A mild reduction in body temperature, to between 89.6 degrees F and 93.2 degrees F, lasting 12 to 24 hours, is needed, said Dr. Jerry Nolan, who helped lead the International Liaison Committee on Resuscitation's Advanced Life Support Task Force.

Nolan, of Royal United Hospital in Bath, Britain and colleagues used a special mattress with a cover that blew air over the body and ice bags to cool patients for 24 hours after they arrived at the hospital.

In an Australian study, paramedics put ice packs against the heads and torsos of patients.

Those patients who were cooled suffered less brain damage, both teams found.

The principal is not surprising -- reducing a person's body temperature before the heart stops, for instance, before open-heart surgery, can prevent brain damage.

"What is so exciting about these new studies is that they showed that even if we cooled the brain after the oxygen supply had been cut off, people did better," Nolan said in a statement released by the American Heart Association, which publishes Circulation.

When brain cells die, they set off a cascade of reactions that can kill neighboring cells, even if they are healthy.

"Cooling slows down the chemical reactions, thereby lowering inflammation," Nolan said.

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FDA OKs New Device to Manage Diabetes

By Lauran Neerguard
AP Medical Writer
The Associated Press
Monday, July 07, 2003

WASHINGTON - Some diabetics will no longer have to add up how much insulin they need for every bite of food.

The Food and Drug Administration on Monday approved the first device that checks a patient's blood sugar, automatically calculates how much insulin they need and signals an implanted pump to send out the right dose.

The Paradigm system is a first step toward developing an artificial pancreas. Diabetes specialists hope the new device will cut down on dosing errors and make it easier for patients to manage their disease.

"The smarter these systems can become ... the better our patients ought to be able to do," said American Diabetes Association past president Francine Kaufman, a pediatric endocrinologist at Children's Hospital of Los Angeles.

Diabetes is a leading cause of blindness, kidney failure and amputations, and dramatically raises the risk of heart attacks. It kills 180,000 Americans each year. Some diabetics control their disease with diet, exercise and various medications; others require regular injections of insulin, a hormone crucial to converting blood sugar into energy.

More than 200,000 diabetics have insulin pumps implanted in their abdomens, a programmable system that can provide more precise, regular doses, infusing even while the patient is sleeping.

Patients still must figure out how much and when their pumps should emit by pricking their fingers to see how much glucose is in their blood and calculating how many carbohydrates they plan to eat. Calculating wrong could cause dangerously high or low doses.

The new system combines a Medtronic MiniMed Inc. insulin pump with a glucose monitor from Becton Dickinson to do a lot of that work automatically.

Patients still will prick their fingers, but the pager-sized monitor uses wireless technology to beam the glucose reading straight to the implanted insulin pump.

Once meal plans are punched in, a calculator in the pump will deliver a dose recommendation by calculating target glucose levels, the patient's insulin sensitivity and how much insulin already is in the blood.

The patient still has final control, and may override the recommended dose.

Medtronic said the prescription-only device will begin shipping July 21 and cost $5,995, $500 more than Medtronic's manually programmed insulin pump.

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Studies Predict Outcome of Kidney Transplants

Adam Marcus
HealthDay Reporter
HealthDayNews
Wednesday, July 09, 2003

WEDNESDAY, July 9 (HealthDayNews) -- Something old and something new could help doctors better predict which kidney transplant patients are most likely to reject their new organs -- and perhaps lead to genetically tailored ways of preventing rejection in those at high risk of the reaction.

What's old is a souped-up version of ultrasound, which shows that stifled blood flow to the kidneys raises the odds of rejection. What's new are computer chips that detect differences in gene activity linked to the severity of a patient's immune response to the donor organ.

Last year, a record 14,769 kidney transplants were performed in the United States, according to the United Network for Organ Sharing.

Although advances in drugs to suppress the immune system have driven down rejection rates for kidney grafts -- 10 percent versus 30 percent a decade ago -- transplant failure remains a significant hurdle for patients. Failure is now the fourth leading cause of end-stage kidney disease in this country.

Doctors have therefore been looking for better ways to improve the odds that transplant recipients will keep their new organs as long as possible and with the fewest hardships.

To that end, two studies appear in the July 10 issue of the New England Journal of Medicine. In one, German researchers showed that using a modern twist on conventional ultrasound to measure blood flow in a transplanted organ can accurately predict which is most likely to fail in the short term.

Patients whose flow was most restricted three months after surgery -- the result of a blocked or kinked renal artery -- were nine times more likely than those with freer flow to suffer a serious rejection or die. The average survival after surgery was 2.5 years in the group with restricted blood flow to the organ, but 23 years for patients with low resistance.

"Prior to this study it wasn't appreciated that this commonly used tool could predict outcomes," says Dr. Philip Marsden, a kidney specialist at the University of Toronto. "Now we recognize that [blood] flow within the kidney is telling us something about how the graft will do in the years ahead."

In the second study, researchers at Stanford University in California used "gene chip" technology to analyze the activity of more than 12,400 genes in the kidney cells of childhood transplant patients. Gene chips are glass or plastic slides that can read genes in a tissue sample and determine which are more or less prominent, providing in the process genetic "signatures" for certain cell types, such as highly aggressive tumors.

The chip found clear patterns in grafts that were healthy and those that were troubled, giving a genetic picture of the risk of organ rejection and response to anti-rejection steroid therapy. A group of 1,340 genes appeared to be most closely related to rejection.

The analysis revealed at least three genetically distinct forms of rejection, based on the nature of the patients' immune cells. These differences weren't visible under a light microscope, the conventional way of examining kidney biopsies. A closer look at these forms found that people with particularly high numbers of immune system B cells in their kidney tissue had a strong risk of severe organ rejection and failure.

"We're pretty excited by what could be the potential practical implications" of the study, says Dr. Minnie Sarwal, a Stanford pediatrician and kidney expert who led the research. "You could actually differentiate which rejection episodes may be the ones with the worst outcomes, which we currently can't do."

B cells had been thought to be mere bystanders in the immune response to an organ transplant, but Sarwal's study changes that view. The immune system "uses these B cells to turbo-charge the T cells [that attack the graft] and makes the rejection response very malignant," she says. Ironically, the success of immune-suppressing drugs makes it possible for B cells to be so potent, she adds.

Marsden, author of an editorial accompanying the journal articles, says neither study holds all the answers to the problem of transplant rejection.

The German research gives doctors a fairly simple tool to predict severe rejection, but it offers nothing to stop it from occurring. The California study shows gene profiles can sort patients into groups with varying degrees of rejection risk and by their response to anti-rejection drugs. But gene chip analysis isn't currently available to most doctors or patients, nor is the function of all the genes in the kidney cells understood.

Still, gene chips hold the promise of leading to customized therapies to prevent organ rejection. As the new study suggests, Marsden says, one of these might involve targeting B cells in certain patients.

More information

Try the United Network for Organ Sharing or the National Kidney Foundation.

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Brushing Right After Drinking Soda May Harm Teeth

By Hannah Cleaver
Reuters Health
Monday, July 07, 2003

BERLIN (Reuters Health) - If you rush to brush your teeth right after drinking soda, think again. Doing so may actually do more harm than good, and it's better to wait 30 or 60 minutes before brushing, according to new research.

Because carbonated drinks are highly acidic and have the potential to damage a tooth's enamel, dentists at Goettingen University, Germany, conducted a study to determine the best time to brush after drinking such beverages. They found that later -- rather than immediate -- brushing is between three and five times more effective at protecting enamel from the erosive effects of carbonated drinks.

In the study, 11 volunteers wore a sterilized piece of tooth-like material in a removable prosthesis for three weeks. This was removed in the mornings and evenings and soaked for 90 seconds in a liquid similar in acidity to soda.

Afterward, the prosthesis was brushed using an electric toothbrush at different times after the 'drink.' Three weeks later, the researchers measured the thickness of the enamel to see how much damage had been inflicted on the 'tooth.'

Professor Thomas Attin, director of the university's department for tooth protection, preventative dentistry and periodontology, said, "The loss of material was less when the participants waited with cleaning for between 30 and 60 minutes."

Professor Attin presented the research at the annual meeting of the German Association for Tooth Protection, where it was awarded a prize from chewing gum firm Wrigley.

He said tooth enamel appears to suffer less damage when brushing occurs after the tooth has had time to mount its own defense against acidic erosion.

Acidic substances attack tooth enamel, he said, and upper layers of the tooth can even be dissolved in some acidic drinks. However, protective agents in saliva may help repair and rebuild damaged tooth enamel.

Waiting for a while seems to give the teeth a chance to rebuild, the researchers said, while immediate cleaning of such teeth can increase the damage by literally brushing off the affected layers.

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What to Watch for with West Nile Virus

HealthDay Reporter
Monday, July 07, 2003

MONDAY, July 7 (HealthDayNews) -- Extreme muscle weakness or paralysis are among the symptoms of West Nile disease.

The finding appears in the July 8 issue of Neurology.

Researchers trying to improve understanding of the disease performed detailed examinations of 23 people with West Nile who were treated at the Cleveland Clinic. Misdiagnosis is still common for people with West Nile.

The study found that 26 percent of the patients experienced a rash as one of the earliest symptoms. That helps distinguish West Nile from another rapid-onset paralytic disorder called Guillain-Barre syndrome, the study says.

Other early symptoms of West Nile include low back pain, limb pain and gastrointestinal complaints. All the patients developed fever at some point in their illness.

Half of the patients experienced muscle weakness, which developed rapidly over the course of three to eight days. In many of those patients, the muscle weakness progressed to all their limbs. In one patient, muscle weakness remained the primary symptom even in the advanced stage of the disease.

Nine of the patients required mechanical ventilation because their breathing muscles became so weak.

The study also found that 75 percent of the patients experienced altered mental status, such as confusion, agitation and lethargy, and other neurological problems such as tremor and seizures.

Overall, three of the patients died as a result of West Nile infection.

"West Nile virus infection can cause significant disability. As the new season begins, it's important for general physicians to be aware of this disease," study author Dr. Lara Jeha says in a news statement.

Early diagnosis of West Nile allows doctors to deal effectively with complications as they arise.

There were more than 4,000 cases of West Nile and 284 deaths in the United States in 2003.

More information

Here's where you can learn more about West Nile virus.

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S.C. Man Has First U.S. Case of West Nile

The Associated Press
Monday, July 07, 2003

COLUMBIA, S.C. - A man who said he was bitten by mosquitoes while fishing has been confirmed as the first human case of West Nile virus in the United States this year, health officials said Monday.

Last year, there were 4,156 total cases of the virus and 284 deaths caused by the disease, according to the federal Centers for Disease Control and Prevention in Atlanta.

The man, whose name was not released, was described as being older than 65 and otherwise healthy. He was released from the hospital last month and has been improving, said C. Earl Hunter, commissioner of the state Department of Health and Environmental Control.

West Nile virus is spread when a mosquito bites an infected bird and then bites a human. It cannot be spread from person to person. The disease produces flu-like symptoms including headaches, swollen glands, muscle aches and a rash.

On the Net:

Centers for Disease Control and Prevention: http://www.cdc.gov/

South Carolina Department of Health and Environmental Control: http://www.scdhec.net/

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Death Rate Higher on Very Hot, Cold Days: Study

By Charnicia E. Huggins
Reuters Health
Monday, July 07, 2003

NEW YORK (Reuters Health) - A higher-than-normal number of deaths occurs during boiling hot or freezing cold weather and the socially disadvantaged are most likely to be affected, according to the findings of a six-year study in seven U.S. cities.

In all cities, those most vulnerable to hot weather-related deaths were blacks, people who died outside a hospital and those with no more than a high school education, the researchers report in the American Journal of Epidemiology.

Deaths among these groups were also slightly more likely during extremely cold temperatures, the report indicates.

"Extreme temperatures are as important as many illnesses in increasing

deaths, and need consistent public health attention," lead study author Dr. Marie S. O'Neill of the Harvard School of Public Health in Boston, Massachusetts told Reuters Health.

"Efforts to reduce mortality on very hot or very cold days should consider that certain population subgroups are at higher risk than others, and that socio-economic circumstances may contribute to increased vulnerability," she added.

Northerners seem to be most at risk of dying during hot spells, another study found, while people living in the southern U.S. are most vulnerable during cold snaps.

However, most studies that have investigated a link between extreme temperatures and mortality have not taken into account the effects of air pollution, according to O'Neill and her colleagues.

Various studies have suggested that air pollution may be associated with an increased risk of cardiovascular disease as well as death in general.

In the current report, the Harvard researchers -- taking air pollution into consideration -- examined the link between temperature and death in Denver, Colorado; Detroit, Michigan; Minneapolis and St. Paul, Minnesota; New Haven, Connecticut; Pittsburgh, Pennsylvania; Chicago, Illinois, and Seattle, Washington, from 1986 to 1993.

They found that in Chicago, for example, respiratory-related deaths were more common in cold weather than in hot weather. In fact, there were nearly 12 percent more deaths in -5 degrees Celsius (23 degrees Fahrenheit) weather than at 15 degrees Celsius (59 degrees Fahrenheit).

And this increased death rate remained evident even after the researchers took into consideration the season, day of the week and other factors that may have skewed the findings, the report indicates.

At a temperature of -5 degrees Celsius in Detroit, the death rate was about 13 percent higher than at 15 degrees Celsius.

"Our data suggest that some of those deaths were due to extreme temperatures, and blacks were more affected than whites," O'Neill said. But, she added, "calculating how many of these deaths are due to temperature would be complicated."

Previous studies have shown that certain features of neighborhoods, such as the amount of pedestrian traffic and public meeting spaces, also affect survival.

Since the researchers in the current study examined death rates across entire cities rather than specific geographical areas, and evaluated death from all causes, future studies should explore specific causes of death as well as community characteristics and other individual- and neighborhood-related factors, the report indicates.

Source: American Journal of Epidemiology 2003;157:1074-1082.

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Sleep Disorders May Have Roots in Brain Chemicals

Amanda Gardner
HealthDay Reporter
Monday, July 7, 2003

MONDAY, July 7 (HealthDayNews) -- Two new studies have found apparent links between different sleep disorders and brain chemistry.

Although these links do not yet mean there is a cause-and-effect relationship, they may be revealing of some of the basic processes underlying sleep disorders.

The studies appear in the July 8 issue of Neurology.

Both studies looked at the same 13 people who have a relatively rare disorder known as multiple system atrophy (MSA), a fatal, degenerative neurological disease that is almost always accompanied by sleep disorders. All the MSA patients in the study also had obstructive sleep apnea and REM (rapid eye movement) behavior disorder.

REM sleep behavior disorder is when people thrash about in their sleep, moan, speak, act out their dreams, get out of bed and even pummel their bed partners, explains study author Dr. Sid Gilman, chairman of the department of neurology at the University of Michigan School of Medicine. This activity occurs during the rapid eye movement -- or REM -- phase of sleep.

Obstructive sleep apnea may affect as much as 3 percent of Americans, many of them undiagnosed. In people with the condition, breathing temporarily stops or diminishes dozens or hundreds of times during sleep. And they snore and have excessive daytime sleepiness. The disorder is also associated with high blood pressure, heart disease and a higher incidence of stroke.

These two studies explored the links between these sleeping disorders and the neurotransmitters dopamine and acetylcholine.

The 13 study participants, along with 27 healthy control subjects, slept in the clinical research center for two nights, hooked up to machinery that measured neurotransmitter levels, brain waves, eye movements, respiration, limb movements and more. The individuals were also videotaped.

In the first study, the researchers wanted to see if dopamine was related to REM sleep behavior disorder.

"We already knew that in Parkinson's disease there's a very high prevalence of REM sleep behavior disorder," Gilman says. "We were suspicious that since Parkinson's is associated with a deficiency in the brain of this neurotransmitter, that we would find an abnormality that is related to the severity of REM sleep behavior disorder. We thought we'd see a correlation, which is exactly what we saw."

The results were exciting and yet not altogether surprising. "We found a very tight correlation [between the severity of REM sleep behavior disorder and the level of decrease in dopamine], so this suggests that there's a causal effect," Gilman says. "We can't prove that. It's a correlation only, but it certainly suggests that the amount of dopamine loss in the brain is related to this disorder."

This finding has led Gilman to wonder if REM sleep behavior disorder could be a very early symptom of Parkinson's.

The second study looked to see if there was a relationship between the severity of obstructive sleep apnea and the degree of decrease of a different neurotransmitter -- acetylcholine.

"Here again, we found a good correlation," Gilman says. "It's not allowing us to conclude but it's certainly suggesting that there might be a causative relationship between obstructive sleep apnea and this neurotransmitter."

Again, this finding raises a number of questions, not the least of which is whether obstructive sleep apnea in healthy people is due to the same type of chemical disturbance. If so, Gilman says, "there might be a whole other way of treating this." Right now, obstructive sleep apnea is typically treated by having the person wear a "continuous positive airway pressure" mask at night to keep the airways open.

"It's an interesting area because it leads to the question of basic science underlying sleep," Gilman says. "It's a somewhat unexpected finding. It could be central to so many things."

More information

For more on obstructive sleep apnea, visit the American Sleep Apnea Association. For more on REM sleep behavior disorder, visit the National Sleep Foundation.

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Premature Girls Have Better Growth Rate

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, July 07, 2003

CHICAGO - Girls born tiny and very premature are more likely than boys born premature to catch up with their peers in growth by age 20, a study found, but the researchers say the difference might actually turn out to favor boys.

While it generally has been considered desirable for premature infants to catch up in size with normal-weight infants, studies also have linked unusually rapid growth in childhood with an increased risk of obesity, heart disease and diabetes later in life.

Most of the catch-up growth in girls studied appeared to occur from ages 8 through 20. And while premature boys were half as likely as normal-birthweight boys to be obese, obesity rates were similar among premature and normal-birthweight girls.

"On the surface it appears that the male very low birthweight subjects might be at a disadvantage," Dr. Maureen Hack and colleagues said. "However, we are more concerned about the future health of the very low birthweight females."

While it's too soon to tell what health problems the young women will face later on, Hack said the findings suggest parents of girls born prematurely should take special care to make sure they have a healthy diet and avoid becoming overweight.

The study appears in the July issue of Pediatrics, published Monday.

The research involved 103 boys and 92 girls born in the late 1970s at Rainbow Babies and Children's Hospital in Cleveland, Ohio, where Hack is a prominent prematurity researcher.

On average, the infants were born about 10 weeks early weighing less than three pounds. They were followed through age 20 and compared in growth with 208 normal-weight youngsters.

Prematurely born girls and normal birthweight girls were both about 5 feet 3 inches at age 20. Girls born prematurely weighed on average about 143 pounds at that age, six pounds less than normal-birthweight girls.

In contrast, the premature boys were 5 feet 7 inches and 152 pounds at age 20 — one inch shorter and 24 pounds lighter than their normal-birthweight counterparts.

Only 7 percent of the premature boys were obese at age 20, about half as many as the normal-birthweight boys. But obesity rates were more similar among premature and normal-birthweight girls — 15 percent and 18 percent respectively.

The prematurely born boys were generally sicker babies than the premature girls, echoing previous prematurity research, though significant prematurity complications including respiratory distress also occurred in the girls.

"We thought that neither of them would catch up," Hack said, so "for the males, it's not that surprising" that they were significantly smaller at age 20 than their peers, Hack said.

The effects of female hormones that kick in when girls reach puberty may partly explain their catch-up growth, Hack said.

Dr. Saroj Saigal, a prematurity researcher at McMaster University in Hamilton, Ontario, said the study echoes previous findings on gender growth differences in adolescents but is one of the few to follow premature infants into adulthood.

"That this catch-up may not be a real advantage" for girls is only speculative, and needs to be proven with more follow-up studies, Saigal said.

It may be that rapid growth during puberty and adolescence is the most problematic, Saigal said.

"Perhaps we should strive for continuing weight gain and catch-up earlier on," when premature babies are still hospitalized, she said. "We're still not able to achieve that."

On the Net:

Pediatrics: http://www.pediatrics.org

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Possible Gene Found for Lou Gehrig's Disease

Reuters Health
Monday, July 07, 2003

WASHINGTON (Reuters) - European researchers say they had identified a new gene that, when mutated, almost doubles the risk of developing the paralyzing disease known as amyotrophic lateral sclerosis, also known as motor neuron disease or Lou Gehrig's disease.

Peter Carmeliet of the Flanders Interuniversity Institute for Biotechnology in Leuven, Belgium, and colleagues found that people with the mutations had 1.8 times the risk of developing. They also found that mice bred with a similar mutation were unusually prone to paralytic disease.

The gene, VEGF, had not previously been associated with ALS, which affects between 1 and 2 in every 100,000 people around the world.

ALS usually develops after age 50, causing gradual weakness, then paralysis and death. There is no cure, although some people progress more quickly than others.

Carmeliet's team had found that mice with a defective version of VEGF, which caused their bodies to produce less VEGF protein than normal, developed a disorder similar to ALS.

They looked at samples from 1,900 people from Sweden, Belgium and Britain and found those with certain mutations of VEGF produced low levels of the protein, too -- and had a 1.8 times higher risk of ALS than the general population.

Furthermore, when they gave VEGF to mice with artificially induced ALS symptoms, the mice got better, they reported in the journal Nature Genetics.

The findings suggest that VEGF plays a role in ALS, they write. "The findings also raise the intriguing question whether more long-term treatment with VEGF might delay the onset or slow the progression of adult-onset motoneuron degeneration as well," they wrote.

VEGF, short for vascular endothelial growth factor, is known to play an important role in blood vessel growth and development, so the finding may also shed light on the underlying causes of ALS.

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Third Congenital Heart Defect Gene ID'd

By Andrew Bridges
AP Science Writer
Associated Press
Monday, July 7, 2003

Scientists have identified a third gene that can cause congenital heart defects, a leading cause of death in newborns.

A malfunctioning version of the gene, called GATA4, can lead to defects in the formation of the walls that separate the four chambers of the heart.

Individuals from families with a history of the common heart defect already are being screened for the mutated gene. Such screenings can prepare them for the possibility their offspring are at risk.

The discovery also could lead to drug or genetic therapies that could fix the problem in fetuses, although such treatments are years away, said study co-author Dr. Deepak Srivastava, of the University of Texas Southwestern Medical Center at Dallas.

Details of the discovery appeared Sunday on the Web site of the journal Nature.

About 25,000 babies born in the United States each year, or as many as one in 125 births, have a heart defect, according to the March of Dimes. Many defects require open heart surgery to repair.

American and Japanese researchers discovered the mutated gene while plumbing the genetic makeups of two multigenerational families plagued by heart defects. GATA4 mutations appeared in all family members with defects, but not in those without, nor did researchers find it in 3,000 unrelated individuals they screened.

The gene, which regulates a host of other genes, is the third known to play a role in heart defects. Researchers believe others remain to be discovered.

Eventually, the gene also could reveal a way of repairing the damage caused by heart attacks in adults, since it appears to regulate heart tissue growth, said Dr. Roberta Williams, a pediatric cardiologist at the University of Southern California who was not connected with the research.

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Children Hit by Migraines

BBC News
Monday, July 7, 2003

US doctors say one in 10 children and one in four teenagers are affected by headaches.

They say the children who experience regular, severe headaches appear to have more emotional problems and difficulties at school than children with other serious, chronic medical conditions such as cancer and rheumatic diseases.

Researchers examined 572 children and teenagers adolescents being treated at the Cincinnati Children's Headache Center.

Virtually all had been diagnosed as experiencing migraines, and 40% had chronic daily headaches.

The children and their parents were questioned about the severity of headaches and the effect on quality of life.

The results were then compared to replies from healthy and chronically ill children.

It was found children who experienced migraines had more problems and school and emotional difficulties than children with other chronic illnesses.

Children with headaches also had a poorer quality of life in terms of performance at school, emotional wellbeing and physical health than healthy children.

Dizziness

Dr Scott Powers, joint director of the Headache Center, said: "Headaches are a common problem found in about one of every 10 children and four adolescents.

"The fact that the impact of these headaches is at least equal to that of childhood illnesses often considered more severe and debilitating suggests that paediatricians and other caregivers should place more emphasis on their recognition, diagnosis and effective treatment."

A spokesperson for the UK's Migraine Action Association said it was known children and even babies could suffer from migraine.

She added: "Sometimes in young children the predominant symptoms are abdominal pain often accompanied by nausea and vomiting and it is only the regular intermittent pattern of the attacks, sometimes coupled with a family history of migraine that suggest the diagnosis.

"When the more typical migraine symptom of headache occurs in children they will often report it in the forehead or the middle of the head rather than on one side.

"Children may also experience symptoms including pallor, sometimes with dark rings around the eyes, dizziness, confusion, lack of co-ordination or occasionally non specific aches and pains in the limbs.

"They often have a tendency to travel sickness."

The Migraine Action Association advises parents keep a diary to establish if there is a pattern to the attacks.

They say avoiding trigger factors, such as long gaps between food, can improve a child's condition.

The research is published in the journal Pediatrics.

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SUNDAY, JULY 6, 2003

Ceramic Revolutionizes Hip-Replacement Surgery

By Gary Gately
HealthDay Reporter
HealthDay Reporter
Sunday, July 6, 2003

SUNDAY, July 6 (HealthDayNews) -- Four months ago, Sal Dassaro's left hip had deteriorated so badly, he couldn't play catch with his sons. Or walk straight. Or climb two steps at once.

Now, Dassaro, 55, not only tosses balls with his two young children, he plays racquetball regularly. He's also walking straight now, and jogging again.

Gone is the pain that used to flash through his groin, and the numbness in his legs and ankles. And he no longer worries about stumbling on the gap between the railroad platform and the New Jersey Transit commuter train he takes several times a week to New York City.

Dassaro owes his new-found freedom of movement to a hip replacement he received in March. But he didn't get the standard replacement hip that has been used for decades. Instead, he received a new type that was approved by the U.S. Food and Drug Administration (news - web sites) just about a month before his surgery.

Rather than the traditional replacement joint -- a metal ball and a plastic socket -- the new technology uses ceramic-on-ceramic joint surfaces.

Dassaro, a furniture and office equipment sales executive, is just the sort of patient who'll benefit most from ceramic hips: graying baby boomers who want to maintain an active lifestyle.

"I feel 10 or 15 years younger," says Dassaro, an Old Bridge, N.J., father of two boys, ages 8 and 11. "Having younger kids, I'm able to keep up with them for the most part, whereas if I didn't have [the hip replacement] done, there was no way."

The human hip joint is known as a "ball-and-socket" because the head of the thigh bone, or femur, moves inside the cup-shaped hollow socket of the pelvis. A total hip-replacement implant consists of a stem, which fits into the head of the thigh bone and provides stability; a ball, to replace the head of the thigh bone; and a cup, to replace the deteriorated hip socket.

In older hip replacements, used in the United States since the 1960s, the metal ball would grind away the plastic cup. The joints tended to wear out in 10 to 15 years. This forced patients to undergo additional replacement surgery, says Dr. Steven Stuchin, director of orthopedic surgery at the Hospital for Joint Diseases of New York University Medical Center.

The life span of the metal-and-plastic joints is even shorter for younger, more active people as tiny particles can break off, leading to deterioration, Stuchin says.

"What we began to see is that, as people live longer and are more active, they put more demand on these joints," Stuchin says. "They literally would wear out. So, the challenge became what could we do that wouldn't wear out?"

Ceramic-on-ceramic joints provide the solution, Stuchin says. They produce less friction, and laboratory test have shown they can last up to 200 times longer than the traditional hip-replacement joint component, he says.

FDA approval of the new ceramic-on-ceramic joints came after tests of the devices by two manufacturers: Wright Medical Group of Arlington, Tenn., and Stryker Corp. of Kalamazoo, Mich.

An orthopedic implant division of Stryker Corp. began clinical studies of ceramic-on-ceramic implants in 1996. The clinical trial consisted of 22 investigations at 16 sites with more than 1,100 patients getting the implants, the company says.

"This ceramic-on-ceramic system has been developed for the younger and more active patient populations who have demonstrated higher wear rates with conventional implants," says Dr. James D'Antonio, associate professor at the University of Pittsburgh and one of the lead investigators in the clinical study.

The FDA recalled devices with ceramic-on-ceramic hip joints in 2001 because of a higher-than-expected fracture rate. But the ceramic used in joints made since then, called alumina, has been found to be better than the older type of ceramic, called zirconia, that prompted the recalls.

Stuchin began doing ceramic hip replacements in New York state after FDA approval of the joints and has done one or two a week since.

"The typical patient is somebody who expects to be quite active and throwing the ball with their kids and going out with their family," Stuchin says. "People are expected to be in the game and in the swim, and our job is to help in that."

More information

For more on hip replacement, visit the American Academy of Orthopaedic Surgeons or the Mayo Clinic.

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Third Congenital Heart Defect Gene ID'd

By Andrew Bridges
AP Science Writer
The Associated Press
Sunday, July 6, 2003

Scientists have identified a third gene that can cause congenital heart defects, a leading cause of death in newborns.

A malfunctioning version of the gene, called GATA4, can lead to defects in the formation of the walls that separate the four chambers of the heart.

Individuals from families with a history of the common heart defect already are being screened for the mutated gene. Such screenings can prepare them for the possibility their offspring are at risk.

The discovery also could lead to drug or genetic therapies that could fix the problem in fetuses, although such treatments are years away, said study co-author Dr. Deepak Srivastava, of the University of Texas Southwestern Medical Center at Dallas.

Details of the discovery appeared Sunday on the Web site of the journal Nature.

About 25,000 babies born in the United States each year, or as many as one in 125 births, have a heart defect, according to the March of Dimes. Many defects require open heart surgery to repair.

American and Japanese researchers discovered the mutated gene while plumbing the genetic makeups of two multigenerational families plagued by heart defects. GATA4 mutations appeared in all family members with defects, but not in those without, nor did researchers find it in 3,000 unrelated individuals they screened.

The gene, which regulates a host of other genes, is the third known to play a role in heart defects. Researchers believe others remain to be discovered.

Eventually, the gene also could reveal a way of repairing the damage caused by heart attacks in adults, since it appears to regulate heart tissue growth, said Dr. Roberta Williams, a pediatric cardiologist at the University of Southern California who was not connected with the research.

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Fight Foot Fungi

HealthDay Reporter
Sunday, July 6, 2003

SUNDAY, July 6 (HealthDayNews) -- There's nothing quite like a warm, dark, moist environment to make fungi feel right at home.

And particularly in the summer, that cozy place can unfortunately be on your feet.

With more than 250,000 sweat glands in the foot, maintaining the kind of ventilation necessary to prevent fungal growth can be a challenge. Failure to do so can lead to such problems as foot odor, fungal nail infections, athlete's foot and other skin infections, warns the American Podiatric Medical Association (APMA).

Common areas of fungal growth are the soles of the feet and between the toes. Signs of infection can include dry skin, itching, scaling, inflammation and blisters that can break and lead to pain and swelling.

If you find your feet plagued with such problems, you're probably not alone in your community -- infections such as athlete's foot are contagious and can be spread not only at warm, humid places such as swimming pools, but even through the sharing of towels.

To prevent fungal infections of the foot, experts recommend changing your shoes daily to let each pair air out. When it's hot or you're working out frequently, socks should be changed even more often, and try to avoid walking barefoot at public pools or locker rooms.

There are a number of over-the-counter anti-fungal foot powders that can be effective in preventing or treating athlete's foot, and even soaking your feet in vinegar and water can help prevent foot odor, says the APMA.

If you do find yourself with an infection, be patient -- it can take several weeks for the problem to clear up. If the condition persists or becomes increasingly painful, it's time to see a doctor.

More information

Here's more from the American Academy of Dermatology on athlete's foot and other foot fungus infections.

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Keep Your Cool While Exercising in Summer Heat

HealthDay Reporter
Sunday, July 6, 2003

SUNDAY, July 6 (HealthDayNews) -- Feeling the "burn" is a part of exercise many people enjoy. Just make sure you don't burn yourself up when you exercise in the summer heat.

If you're not careful, the combination of heat and exercise could turn your workout into a serious medical problem.

When you exert yourself, muscle activity leads to an increase in body temperature. Your body maintains its internal temperature by sweating. But your body's natural ability to cool itself can be overwhelmed by the combination of intense exercise and hot weather.

That can lead to dehydration, which can cause muscle cramps, fatigue, headache, lightheadedness, confusion and lethargy. Ignoring those warning signs can lead to heat exhaustion, putting you at risk for coma, cardiac arrhythmia, even death.

The University of Massachusetts offers the following tips on how to stay safe when you exercise in the summer heat:

  • Make sure you drink enough fluids before you exercise or do any kind of physical activity. Drink eight to 10 ounces of water, 10 to 20 minutes before starting a light workout.
  • If you're exercising or playing a sport for an hour or more, make sure you take breaks to drink water. You should be drinking three ounces of water every 20 minutes.
  • Don't use salt tablets.
  • Wear a hat or some other type of head covering that protects your head from the sun.
  • If you start to overheat, sponge or spray water on your skin to assist your body's cooling process. The water on your skin helps dissipate heat.

More information

The University of Michigan has much more on how to protect yourself against heat stroke.

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SATURDAY, JULY 5, 2003

Stomach Surgery for the High School Set

By Kathleen Doheny
HealthDay Reporter
HealthDay Reporter
Saturday, July 5, 2003

SATURDAY, July 5 HealthDayNews) -- Three years ago, Zac Reynolds was an unhappy 15-year-old who'd often stay home on Saturday nights, choosing solitude over invitations to go out with friends.

No more.

Today, the Hampton, Va., teen has a zest for life and he's much more outgoing. Besides enjoying time with friends on a Saturday night, he's finishing his senior year of high school, works as a part-time landscaper and spends his spare time tinkering with his car.

His life, he says, has taken "a 180-degree turnaround. Everything seemed to get more positive."

What made the dramatic difference? A 143-pound weight loss, thanks to a type of obesity, or bariatric, surgery that drastically reduces the size of the stomach.

Reynolds, who is 5-foot-7, weighed 318 pounds before his gastric bypass surgery. Now, he weighs 175.

While health experts are divided over the wisdom of performing such surgery on teens, Reynolds is sure it was the right decision for him.

"I had tried a lot of the diets that are out there. None of them worked very well," he says.

Proponents of such surgery for teens -- including Reynolds' surgeon, Dr. Harvey Sugerman -- say it can be life-changing for the right candidates.

Critics caution that bariatric surgery, especially for teens, must be a last resort, and they worry about the procedure's effect on normal growth patterns.

The debate won't die down soon, statistics suggest. Roughly 15 percent, or 9 million American children and teens aged 6 to 19, are overweight, according to the National Center for Health Statistics, citing data from 1999 and 2000. That's triple the number who were overweight in 1980.

Gastric bypass surgery is the best solution for certain obese teens, says Sugerman, the David M. Hume Professor of Surgery at Virginia Commonwealth University.

"We don't think this should be done unless the adolescent has significant medical problems related to their obesity," he says.

Often, they do have such problems.

Reynolds, for instance, was struggling with knee trouble caused by his weight. "And there is a history of diabetes in my family," he says; the doctors were worried he might be prone, too.

Some obese teens have sleep apnea, a condition in which breathing stops temporarily during sleep. And young women can suffer from polycystic ovary syndrome -- when ovulation stops.

To critics who say bariatric surgery shouldn't be done on teens who are still growing, Sugerman says, "We don't feel that's a good argument."

In a 20-year review of 33 teen bariatric surgery patients published earlier this year in the Journal of Gastrointestinal Surgery, Sugerman and his team found that none had delayed or impaired physical or sexual maturation.

Their average body mass index (BMI) was 52 before the surgery. After the surgery, the teens' average BMI was 38. (BMIs of 25 and higher are termed overweight; those 30 and above are considered obese. For instance, a person who is 5-foot-8 and weighs 342 pounds has a BMI of 52.)

The teens who had the surgery also reported enhanced self-image, Sugerman says.

But the operation isn't a magic bullet, as Sugerman cautions: "It is a tool to help them help themselves. It is not a free ride, not a be-all-and-end-all."

While the surgery is designed to provide built-in calorie restriction due to the smaller stomach size, "it can be beaten with the ingestion of high-fat junk food," Sugerman says.

Procedures vary, but the one done on Reynolds "involves making a very small stomach pouch and then you disconnect the upper part of the stomach from the lower and make it a tablespoon-size stomach," Sugerman says.

After the operation, teens are counseled about diet. "We try to get them to eat a balanced, regular diet without potato chips," Sugerman says. Exercise is recommended, too.

Reynolds, who walks for exercise and gets plenty of physical activity during his landscaping job, says he also watches what he eats. If he slips up and consumes high-fat fast food, he says, "it gives me a stomachache."

Despite the success stories, not all doctors are convinced such drastic surgery is right for young patients.

Dr. Timothy Sentongo is a gastroenterologist at Children's Memorial Hospital in Chicago who does not perform bariatric surgery. He says, "We need more studies to find out how safe the surgery is."

Even after those studies are in, such surgery should not be "the first approach," Sentongo adds. He does see a limited role for it if diet and exercise fail and the teen's health is compromised by the obesity.

Parents and teens who think bariatric surgery might be an option should choose their surgeon carefully, says Sugerman. He recommends a surgeon with lots of experience.

"See if the doctor is board certified as a surgeon. Find out if he or she is a member of the American Society for Bariatric Surgery," he advises.

More information

For more information on obesity among teens, see the National Center for Health Statistics. For details on obesity surgery, visit the American Society for Bariatric Surgery.

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B-Vitamin Problems May Cause Depression in Some

By Alison McCook
Reuters Health
Saturday, July 5, 2003

NEW YORK (Reuters Health) - New findings suggests that some people with depression might have problems metabolizing the B vitamin folate -- supporting the idea that supplements could help ward off the condition, researchers say.

Investigators in Norway found that depression occurred more commonly in people who had high levels of the amino acid homocysteine in their blood, and in those who carried a form of a gene that encodes a protein involved in processing folate.

Homocysteine is a normal byproduct of metabolism, and folic acid -- the form of folate found in supplements -- is known to aid in breaking down homocysteine.

"Lack of folate and/or a disturbed folate metabolism ... may partially be the cause of the depression in some people," study author Dr. Ingvar Bjelland of the University of Bergen told Reuters Health.

Previous research has suggested that folic acid supplements may boost the effects of antidepressants, an idea supported by the current study, Bjelland said.

The results, which appear in the Archives of General Psychiatry, "could even support the suggestion that folate may prevent depression," the researcher noted.

Bjelland and colleagues obtained their findings by scanning blood samples from 5,948 people between the ages of 46 and 49, and screening them for depression and anxiety.

The researchers found that people who had relatively high levels of homocysteine in their blood were almost twice as likely to be depressed, relative to people with the lowest blood levels of homocysteine.

According to the report, depression was also linked to a form of the gene for a folate-processing enzyme associated with poorer efficiency in the breakdown of folate.

Anxiety, however, was not related to either homocysteine or the folate-processing enzyme.

Although markers of folate metabolism appeared altered in depression, actual levels of folate in the blood did not appear to differ between people with and without depression.

Bjelland noted that while this result is surprising, measuring folate in the blood may, in fact, be a "less precise" indication of how much folate is actually in cells.

"In addition, in our study the laboratory method of measuring homocysteine was more accurate than the method for folate," Bjelland said.

Explaining why folate might play a role in depression, the researcher said the body may need the B vitamin to build important substances in the brain -- a lack of which may cause depression and other mental disorders.

To Bjelland, the current study supports a simple message: get your vitamins.

"Vitamins are important, not only for the physical health, but for the mental health as well," the researcher said.

Source: Archives of General Psychiatry 2003;60:618-626.

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The Silent Killer

HealthDay Reporter
Saturday, July 5, 2003

SATURDAY, July 5 (HealthDayNews) -- Just because the home heating season is over doesn't mean you're free from the dangers of carbon monoxide (CO) poisoning.

While faulty furnaces, fireplaces and other heating devices make CO poisoning more common in the winter, it can happen in the summer. For example, improperly maintained gas-fired stoves, fridges, water heaters and other appliances in your home can be a threat in any season.

A car left idling in the garage can fill a home with CO. Riding in the enclosed bed of a pickup truck, or riding in a camper or a motor home also pose the risk of CO poisoning, says the Washington State Department of Health.

CO is a colorless, odorless, potentially deadly gas that is produced by incomplete combustion. Because you can't smell it, taste it or see it, it can kill you and your family before you have any warning that something is wrong.

Mild CO exposure can cause dizziness, headache, weakness, confusion, poor hand-eye coordination, nausea, visual problems and chest pains in people with heart problems. Prolonged or major exposure can result in unconsciousness and death.

The severity of symptoms varies depending on CO concentration, length of exposure, degree of physical activity, and health of the people exposed to CO.

CO poisoning is easily prevented. If you have fuel-burning appliances, have them checked and keep them maintained so that they function properly. Homes with fuel-burning appliances should have at least one CO detector/alarm.

Contact your gas company if you suspect a natural gas leak in your home, smell combustion fumes from your appliances, or have symptoms that may be caused by CO exposure.

Never run your car in an enclosed garage, and make sure to check and maintain the exhaust system on your car, camper or motor home.

More information

The U.S. Environmental Protection Agency (news - web sites) has more about CO safety.

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Study Finds No Link Between Cooked Potatoes, Cancer

Reuters Health
Saturday, July 5, 2003

NEW YORK (Reuters Health) - A study conducted in Europe has failed to turn up an association between eating fried or baked potatoes and an increased risk of cancer, according to an international team of researchers.

Swedish scientists sparked a worldwide food scare last year when they found high levels of acrylamide, a suspected human carcinogen, in high-carbohydrate foods including crackers, certain cereals and cooked potatoes.

The new study provides "reassuring research evidence for the lack of an important association between consumption of fried and/or baked potatoes and cancer risk," according to the report in the International Journal of Cancer.

However, the findings may not be applicable to all countries, which may have different eating habits than the population studied, the researchers say.

In the study, Dr. Claudio Pelucchi, of the Istituto di Ricerche Farmacologiche in Milan, Italy, and colleagues re-examined a series of studies conducted in the 1990s involving more than 7,000 Italian and Swiss men and women with various types of cancer.

All of the men and women answered questions pertaining to diet and, specifically, how often each week they ate fried and/or baked potatoes and how large a portion. In each study, cancer patients were compared to a larger group of healthy people.

The team reports that they found no evidence for an interaction between fried or baked potato consumption and cancer.

Even so, Pelucchi and colleagues say their findings are limited to southern European populations that use different cooking processes and cooking oils than northern Europeans and Americans do.

"There is no indication, however, that the (cooking oil) used is a crucial factor in the generation of acrylamide during frying or baking of potatoes," the authors write.

Cancer types among those with the disease included cancer of the mouth, pharynx, esophagus, larynx, colon, rectum, breast or ovary.

Acrylamide is a colorless compound labeled as a probable carcinogen based on data from animal research.

Scientists believe acrylamide is formed during the cooking process, when starchy foods like potatoes, rice and cereals are fried or baked at high temperatures.

Source: International Journal of Cancer 2003;105:558-560.

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