Breast Implants not Linked to Brain Cancer (January 26, 2004) 

(Ivanhoe Newswire)

Previous studies suggest women with silicone breast implants have more than a two-fold greater risk of developing brain cancer. However, a new study shows no correlation between the two.

Researchers from the International Epidemiology Institute examined four long-term studies that included nearly 10,500 women with breast implants. Some of the women were followed for almost 30 years. Researchers found only 12 of the women in the study developed brain cancer. Based on population statistics, researchers expected to find about 10 cases of brain cancer. However, they say the difference in observed and expected cases was not statistically significant.

The current findings contrast a 2001 study that showed women with breast implants had more than double the risk of dying from brain cancer. Researchers say that study had many limitations. They say researchers relied on death certificates as the only source of information for brain cancer diagnosis. The current study required complete medical records and a long-term follow-up of a very large group of participants.

The Food and Drug Administration placed a moratorium on the use of silicone breast implants in 1992. However, researchers say no studies have shown significant evidence that breast implants increase the risk of cancer. Authors of the study conclude, “Our results add to the large body of scientific evidence finding no increased risk of brain cancer or other diseases in women with breast implants.”

SOURCE: Annals of Plastic Surgery, 2004;52:115-117

Prenatal Testing for All Moms (January 23, 2004) 

(Ivanhoe Newswire)

A new study disputes the conventional view that the cost-benefit ratio of prenatal testing makes it appropriate only for women ages 35 or older.

Prenatal testing guidelines recommend offering amniocentesis or chorionic villus sampling (analysis of placenta cells) only to women 35 years or older or for women who have been through screening to be at a high risk of giving birth to an infant with a chromosomal abnormality, such as Down syndrome. This threshold was chosen, in part, because 35 was the approximate age at which amniocentesis was cost-beneficial when testing guidelines were developed in the United States in the 1970s.

Researchers from the University of California, San Francisco, did a cost-utility analysis of chorionic villus sampling and amniocentesis compared with no invasive testing using data from 534 diverse pregnant women ages 16 to 47. The investigators found prenatal diagnostic testing is cost effective regardless of age or risk at the time of testing (less than $15,000 per quality-adjusted life year gained for each woman).

Investigator Miriam Kuppermann, Ph.D., says, "Prenatal diagnostic testing should be offered to pregnant women irrespective of maternal age or risk, and guidelines should emphasize the important role of individual preference when making decisions about prenatal diagnostic testing."

In an accompanying commentary, Stavros Petrou, Ph.D., from the University of Oxford, says the decision to offer prenatal diagnostic testing to all pregnant women may have broader consequences for obstetric and other health services. He concludes: “In many cash-limited systems, there would be a knock-on effect of increased service provision and need for training on the availability of staff for other services. A single economic evaluation provides necessary but insufficient information about the appropriate level of service.” Petrou says more research is needed to choose how to allocate resources between options.

SOURCE: The Lancet, 2004;363:276-282, 258-259

Reducing Cigarette Count not Enough (January 23, 2004) 

(Ivanhoe Newswire)

Smokers who substantially reduce the number of cigarettes they smoke per day are exposed to lower amounts of a potent tobacco carcinogen, or cancer-causing agent. However, the reduction in the amount or concentration of the carcinogen exposure is often temporary and not proportional to the reduction in cigarettes smoked.

Researchers from the University of Minnesota Cancer Center measured the metabolites of a specific tobacco carcinogen, NNK, in the urine of smokers who were part of a smoking reduction program. The results would show whether smokers who reduce the number of cigarettes smoked per day also decrease their risk of lung cancer.

Investigators report an overall reduction in carcinogen levels at nearly all of the study intervals as the 92 patients who completed the study reduced the number of cigarettes smoked each day. Authors of the study say the results suggest people who are trying to cut back by smoking fewer cigarettes per day alter their smoking behavior by inhaling longer and deeper, which is known to alter a smoker’s exposure to carcinogens. The investigators conclude, “The results indicate that some smokers may benefit from reduced smoking, but for most the effects are modest, probably due to compensation.”

In a commentary in the same issue of the Journal of the National Cancer Institute, a team of epidemiologists reviewed the association between smoking and cancers not previously believed to be associated with tobacco use, such as cancers of the stomach, liver and kidney. Authors of the study say: “Although 1 billion people worldwide already smoke and more will start, individuals who stop smoking reduce their smoking-related cancer risks effectively. A balanced public health strategy is therefore needed that not only prevents young individuals from starting to smoke, but also helps adults stop smoking.”

In an accompanying editorial, researchers from the National Cancer Institute discuss how the two studies highlight that tobacco’s role as a cancer initiator and promoter is not only complex, but also remains one of the greatest global public health challenges. Given the strong evidence, NCI researchers say the most dramatic health benefits in the next half-century will happen when the number of smokers who quit significantly increases. Cigarette smoking is the cause of 90 percent of the world’s lung cancer cases.

SOURCE: Journal of the National Cancer Institute, 2004;96:107-115

Best way to Treat Asthma (January 23, 2004) 

(Ivanhoe Newswire)

Recommendations to double the dosage of inhaled steroids at the start of asthma attacks are challenged by research findings in the latest issue of The Lancet. This approach is widely advocated but investigators say it is of unproven value.

Researchers from the Department of Respiratory Medicine at Nottingham City Hospital in England studied 390 asthma patients, age 16 or older, who are at risk of an asthma exacerbation and who take an inhaled corticosteroid each day. Patients monitored their asthma for up to one year and were instructed to add an extra inhaler (either steroid or placebo) for two weeks when their asthma control deteriorated.

Results of the study show there was no statistically significant difference in the proportion of people requiring oral steroids between the active and placebo groups. In both groups around 12 percent of patients required oral steroids. In the active group, 22 of the 192 participants started prednisolone compared to 24 of 198 participants in the placebo group. There was also no statistically significant difference in the proportion of patients who visited their general practitioner or who were prescribed antibiotics.

Investigators say one reason doubling the dose is ineffective is the slow onset of inhaled corticosteroid action compared with the rapid deterioration in asthma control may not leave enough time for inhaled corticosteroids to prevent an exacerbation. Lead researcher Tim Harrison recommends, “Until more data are available, patients should continue to take a short course of oral steroids for asthma exacerbations."

SOURCE: The Lancet, 2004;363:271-275

Vitamins Prevent Alzheimer’s (January 22, 2004) 

(Ivanhoe Newswire)

Need another reason to start taking your vitamins? New research shows vitamin supplements, particularly vitamin E and C supplements, may protect against Alzheimer’s disease.

Researchers from Johns Hopkins Bloomberg School of Public Health examined data from a large study that evaluated the occurrence of Alzheimer’s disease in patients aged 65 years and older. Participants were asked about vitamin usage. About 17 percent of patients reported taking vitamin E or vitamin C supplements. These patients were more likely to be females, younger, more educated and in better health than those who did not take the supplements. Twenty percent of patients reported taking multivitamins without high doses of vitamins E and C.

Results show patients who took a combination of vitamin E and vitamin C supplements were less likely to develop Alzheimer’s disease. However, there was no significant reduction in the risk of Alzheimer’s when the vitamins were taken alone or as part of a multivitamin. Researchers say multivitamins typically contain the recommended doses of vitamins E and C, while individual supplements often contain more than double the recommended doses.

Peter P. Zandi, Ph.D., lead author of the study, says, “These results are extremely exciting. Our study suggests that the regular use of vitamin E in nutritional supplement doses, especially in combination with vitamin C, may reduce the risk of developing Alzheimer’s disease.”

Researchers say vitamins E and C may offer protection against Alzheimer’s when taken together in higher doses. They also say vitamin E may offer some protective effect when combined with the lower doses of vitamin C found in multivitamins. Zandi concludes, “Further study with randomized prevention trials is needed before drawing firm conclusions about the protective effects of these antioxidants. Such trials should consider testing a regimen of vitamin E and C in combination.”

SOURCE: Archives of Neurology, 2004;61:82-88

Alcohol Gene Identified (January 21, 2004) 

(Ivanhoe Newswire)

Scientists believe they have found a gene that predisposes people to become alcoholics.

Publishing in this month’s Alcoholism: Clinical and Experimental Research, investigators from Washington University School of Medicine in St. Louis and elsewhere report results from a study involving 262 families with alcoholic members. All were assessed for three genes in an area on chromosome 15 that had previously been linked to alcoholism.

Results showed one of the genes -- GABRG3 -- did appear to influence alcoholism risk. Researchers aren’t sure how the gene predisposes someone to alcohol dependence, but note the gene is related to a receptor that allows Gamma-amino butyric acid (GABA), the major inhibitory chemical in the central nervous system, to move between nerve cells. Other studies suggest alcohol abuse and dependence might be related to an overactive central nervous system. Alcohol may calm this over activity, leading people who have inherited the condition to develop alcohol dependence.

The investigators are quick to point out, however, many factors are likely involved in becoming an alcoholic and just inheriting the right genes is only part of the picture.

“One reason it is so difficult to find genes involved in psychiatric disorders is that there is an interplay between genetic and environmental factors,” says study author Danielle M. Dick, Ph.D. She says, “A person can carry all kids of genes that predispose them to alcohol dependence, but if they never take a drink, they won’t become an alcoholic.”

SOURCE: Alcoholism: Clinical and Experimental Research, Jan. 2004

Circulation and Blood Vessel Problems for Diabetics (January 21, 2004) 

(Ivanhoe Newswire)

A recent study shows only 7 percent of diabetics take the proper preventative measures to avert circulation and blood vessel problems.

Researchers from the Centers for Disease Control and Prevention sampled nearly 1,700 adults, ages 20 years or older, who had been diagnosed with diabetes for more than a decade.

The researchers examined levels of glycosylated hemoglobin (blood glucose levels), blood pressure, and cholesterol and discovered that many patients with diabetes were not proactively managing these factors. Researchers stressed continued negligence by diabetics increases their risk for vascular disease including retinopathy, neuropathy, nephropathy, coronary heart disease, stroke, and lower extremity amputations.

The research showed 37 percent of patients were above the recommended HbA1c level of 8 percent or greater, 40 percent had hypertensive blood pressure, and 52 percent had cholesterol levels of 200 mg/DL or greater. People with cholesterol levels of 200 mg/DL or greater are at borderline high risk, and sometimes even high risk, for heart disease.

The authors conclude, "Ongoing monitoring and measurement of the quality of care, empowering clinicians with medical decision support tools and patients with information to improve the quality of care they receive, and building incentives for providing comprehensive care into the health care delivery system are essential to translating into practice the therapies that have been proven effective in reducing the risk of vascular disease in individuals with diabetes."

SOURCE: Journal of American Medical Association 2004;291:335-342

Medication Decreases Chest Pains (January 21, 2004) 

(Ivanhoe Newswire)

A new treatment may reduce the frequency of angina attacks and help chronic chest pains sufferers exercise longer, according to new research.

Researchers at the St. Louis University School of Medicine say when the drug ranolazine is taken with other antianginal medications, it improves the total exercise time of patients with symptoms of chronic angina. In background information, they say the nearly 7 million patients suffering from chronic angina report limitations of their work and other activities two to three times more frequently than the general population. Also, 26 percent of patients still experience angina attacks despite current treatments, such as myocardial revascularization -- a surgery that helps restore blood flow to the heart and is done largely to prevent angina -- and antianginal drugs.

Ranolazine is currently under review by the FDA. For this study, more than 800 patients with symptomatic chronic angina were randomly assigned to receive a placebo or one or two doses of ranolazine. Patients received either placebos twice a day or 750 mg or 1000 mg of ranolazine. Then, they were monitored as they exercised on a treadmill 12 hours after receiving the medication (when it was at the lowest levels in the bloodstream) and four hours after receiving it (when there were the highest levels of the drug in the bloodstream).

Researchers found that when added to a standard dose of frequently prescribed antianginal drugs, ranolazine can reduce both the angina frequency and nitroglycerin consumption. When compared to the placebo results, the decrease in angina attacks were slightly less than one per week for those in the 750 mg group and somewhat more than one per week in the 1,000 mg group. They also found exercise duration increased by nearly two minutes for those in the ranolazine therapy group compared with 90 seconds for those taking placebos.

In an accompanying editorial, Peter Berger, M.D., of Duke University Medical Center in Durham, N.C., says the availability of another effective and apparently safe antianginal medication is “particularly important” for angina patients who are not candidates for revascularization.

SOURCE: Journal of American Medical Association, 2004;291:309-316

Improving Gene Therapy (January 21, 2004) 

(Ivanhoe Newswire)

New research shows a form of gene therapy capable of entering the bloodstream and traveling directly to the part of the body that needs treatment may be on the horizon.

Gene therapy works by inserting modified genes to treat an illness or condition into a virus that has been made harmless to humans. But injecting these gene-carrying viruses into a person’s bloodstream has been a problem, because most of the virus ends up in the liver, which naturally isolates foreign bodies and washes them out of the blood. That makes it difficult to deliver enough of the new genes to the part of the body that needs assistance.

Scientists from the University of Glasgow in Scotland have now developed a “designer” gene therapy that bypasses the liver. The new therapy uses an adeno-associated virus, or AAV, which has been redesigned to avoid capture by the liver long enough to get to the part of the body needing the new genes. They’ve tested two forms of the virus in the laboratory and in mice, using it to deliver new genes to vascular endothelial cells, which are the cells that line the inside of blood vessels. These cells play a major role in many cardiovascular abnormalities. The investigators redesigned the virus by modifying two small proteins called peptides.

More work will be needed before the therapy can be tried in humans, but the authors believe these findings hold promise for the future. Lead investigator Andrew H. Baker, Ph.D., comments, “This work shows for the first time that this is possible using cell-specific peptides to modify AAV vehicles for systemic gene delivery.”

SOURCE: To be published in an upcoming issue of Circulation

No Pain, No Gain (January 21, 2004) 

(Ivanhoe Newswire)

A new study in the Annals of Internal Medicine suggests people with low back pain can benefit from regular exercise, even if it hurts.

Low back pain is a common complaint and one that causes excessive absence from work. Many doctors recommend an exercise program for these patients aimed at returning them to normal activity levels. But many people with lower back pain balk at exercise because of the pain involved.

This study was conducted among the employees of an airline company in the Netherlands. About 135 workers who had regularly missed work due to low back pain were assigned to either usual care or to a physical exercise program supervised by a physiotherapist.

Workers in the treatment group exercised twice a week for an hour. The program consisted of general and individually tailored exercises, both of which had to be performed during each session. General exercises were aerobic in nature, such as cycling or rowing, or strengthening. The strengthening exercises consisted of floor abdominal sit-ups, dynamic back extensions, leg-presses, latissimus pull-downs, and standing up from a low chair.

The individually tailored exercises were based on work-related tasks. For example, a worker who reported back problems while lifting suitcases from a luggage wagon onto an airplane might be instructed to practice lifting and moving a suitcase a set number of times. The physiotherapists insisted the workers continue to exercise, despite any pain or discomfort.

All the workers in the study were followed for six months. Those who participated in the exercise program missed only 58 days of work, compared to 87 missed days of work for those receiving usual care.

SOURCE: Annals of Internal Medicine, 2004;143:77-84

Lighting up Acne (January 19, 2004) 

WASHINGTON (Ivanhoe Newswire)

Despite what your mother might have told you, chocolate does not cause acne, but doctors say hormones, genetics and bacteria do. And for some, numerous treatments don’t help. Here’s a new treatment that’s showing promise.

It may look like 17-year-old Nicole Toueg is at a tanning salon. Instead, she’s being treated for severe acne. “It’s embarrassing,” she says. “Like, younger kids, they would be like, ‘What’s wrong with your face?’”

Over the last five years, Toueg has tried numerous medications and creams. She says nothing worked until this high-tech treatment. It’s called ClearLight.

“It works by killing the bacteria that produce acne,” says Washington, D.C., dermatologist Dale Isaacson, M.D. With the ClearLight system, patients receive eight to 12 treatments. Dr. Isaacson says 90 percent of the time bacteria is killed and suppressed for up to six months.

Toueg says it’s helping. “Actually, like physically, about a 50 percent improvement. But, like for myself, it’s been about like 75 -- just, like, the way I feel and stuff,” she says.

Christine Fogt had 12 ClearLight treatments after five years of medications. She says, “No more medication. I saw the effects within the fifth session and then, ever since then, I haven’t gone back on any medication.” Now, she says she doesn’t linger in front of the mirror scrutinizing her face.

Dr. Isaacson says the ClearLight system is still new and is in about 20 offices around the country. In his experience, insurance companies are paying between 30 percent and 50 percent. He expects that to increase when the treatment becomes more widely available. However, he says not all insurances will cover the procedure.


If you would like more information, please contact:
Donna Kuncl
Cosmetic/Laser Technician
1828 L Street, NW
Suite #850
Washington, D.C. 20036
(202) 822-9591
http://www.dcdermdocs.com

Women at Risk in the ICU (January 16, 2004) 

(Ivanhoe Newswire)

Women are less likely than men to survive a stay in the intensive care unit, report researchers publishing in this month’s Archives of Internal Medicine.

Observational studies and studies conducted in animals suggest gender may influence disease development and could play a role in determining who survives a stay in the ICU. Doctors know, for example, women have a lower overall rate of coronary heart disease, but a higher rate of early mortality from heart attacks compared to men. However, animal studies indicate males have higher mortality rates in other areas than females, and suggest hormonal differences may be coming into play. Few studies, however, have looked at mortality differences in a clinical population.

Researchers from Belgium collected data on all patients admitted to one 31-bed medical-surgical ICU. There were 4,420 admissions overall, 1,587 women and 2,833 men. During the two study periods, women had about a 1.18-times greater risk of dying in the ICU than men. After adjusting the findings to take other factors that could have influenced mortality into account, the differences were deemed significant for women over age 50. The highest mortality rate was among older women in the first few days of ICU admission. The longer a younger woman stayed in the ICU, the more her chances of dying approached those of men.

The authors believe these findings suggest hormonal changes may be responsible for the higher death rates among older women. They call for “additional prospective studies observing not only sex but also hormonal status ... to further characterize these differences.”

SOURCE: Archives of Internal Medicine, 2004;164:61-65

Artificial Amniotic Fluid (January 16, 2004) 

ST. PETERSBURG, Fla. (Ivanhoe Newswire)

When babies are born premature, one of the challenges is getting them to tolerate breast milk or formula. New research shows mimicking nature may overcome that challenge.

Baby Jarell got an early start to life. “He was two pounds and 10 ounces, and when he came out, he came out crying,” Jarell’s mother, Richelle Taylor-Harris, tells Ivanhoe.

As a preemie, Jarell has one goal. Neonatologist Darlene Calhoun, D.O., of University of South Florida/All Children’s Hospital in St. Petersburg, says, “If you are born prematurely, your ticket to going home is basically gaining weight.”

But that’s not always easy. When babies are in the womb, they swallow amniotic fluid. The fluid helps the digestive system develop properly. When babies are born premature, they no longer swallow amniotic fluid and can’t tolerate breast milk or formula yet. Now, a new option is being tested.

Dr. Calhoun helped develop artificial amniotic fluid. The solution has growth factors to help intestines digest food sooner. She says, “Our goal is if you can go onto feeds faster, this will ultimately shorten the babies’ hospitalization.”

If every preemie shortened their hospital stay by just one day, Dr. Calhoun says it would save $250 million. But, there’s more than a financial gain.

“I think it gave Jarell an extra boost to get started,” Richelle says. Three weeks ago, Jarell was given the fluid as part of a clinical trial. Mom admits she was nervous. “No, no he’s not going to be a research project, but he listened to what they said, thank goodness,” she says. Jarell is now 3.5 pounds and growing -- perfect, but little, and waiting for one more big step. “To go home. Get him home,” these parents say.

The artificial amniotic fluid was tested in 70 premature babies, and researchers say there were no negative side effects. It’s now being studied in a second clinical trial. Researchers say another benefit of the fluid is that it helps get a baby off IV sooner, which reduces the risk of infection.

If you would like more information, please contact:
Ann Miller
Media Relations Manager
All Children’s Hospital
millera@allkids.org

Simple Precautions to Lower SIDS (January 16, 2004) 

(Ivanhoe Newswire)

Taking simple precautions could significantly lower the incidence of sudden infant death syndrome, or SIDS.

That’s the main finding from a new study in this week’s The Lancet. Researchers conducted studies in 20 centers in Europe, looking at 60 variables from the medical records of 745 SIDS cases and 2,411 healthy infants to identify risks for SIDS.

About 48 percent of all the SIDS cases were attributed to sleeping in the side or prone position. Around 16 percent of the cases were caused by bed-sharing. Infants were also more likely to succumb to SIDS if bedding had covered their heads or if they slept with a mother who smoked or drank alcohol, especially in the first two weeks of life. However, among mothers who did not smoke during pregnancy, the risk associated with bed-sharing was significant only in infants younger than 8 weeks.

Interestingly, about 36 percent of the SIDS cases were attributed to the baby sleeping in a separate room from the parents. On average, babies who died of SIDS were put to bed in a separate room 26 days earlier than those who did not. The investigators say they are not sure why sleeping in a separate room would increase the risk for SIDS.

The authors conclude, “Avoidable risk factors such as those associated with inappropriate infants’ sleeping position, type of bedding used, and sleeping arrangements strongly suggest a basis for further substantial reductions in SIDS incidence rates.”

SOURCE: The Lancet, 2004;363:185-191

Best Care for Low Birth Weight Babies (January 15, 2004) 

(Ivanhoe Newswire)

Low birth rate is the leading cause of infant mortality. A new study examines which factors should be considered when choosing a hospital to care for these fragile babies.

Background information in the study article explains that evidence-based selective referral strategies are being used by a growing number of insurance companies to ensure medical care is provided by high-quality providers. They’re also being used to ensure patients with high-risk conditions are being treated in hospitals with the best outcomes. The current standards in place for many conditions rely on indirect quality measures such as patient volume.

After examining the records of more than 90,000 very low birth rate infants born between January 1, 1995 and December 31, 2000, the researchers conclude that insurers should use “direct-quality indicators,” like survival rates at hospitals rather than patient volume to choose the best hospital. Results show in hospitals with less than 50 annual admissions of very low birth weight infants, an additional 10 admissions were associated with an 11-percent reduction in mortality. Jeannette A. Rogowski, Ph.D., of RAND in Arlington, Va., and her colleagues say historical volume was not significantly related to mortality rates, implying that volume alone cannot prospectively identify high-quality providers.

Researchers say the difference in mortality between the best and worst hospitals was more than five-times larger when ranking hospitals on past-mortality rates compared with ranking hospitals on past volume. They conclude, “Moving patients out of hospitals with high past mortality and into hospitals with lower past mortality will have a larger impact than moving patients from low-volume to high-volume hospitals.”

SOURCE: Journal of American Medical Association, 2004;291:202-209

Measuring the Effects of Vision Loss (January 15, 2004) 

(Ivanhoe Newswire)

People who suffer from diabetic retinopathy (DR) report significant restrictions resulting from their condition, report researchers who conducted a study published in this month’s issue of the Archives of Ophthalmology.

When the visual acuity in the better eye drops below 20/40, many patients begin to experience ill effects.

Diabetic retinopathy is a major cause of vision loss among adults. About 22 percent to 36 percent of all diabetics in the United States and Australia suffer from the condition. Vision impairment caused by the disease often leads to dependency in activities of daily living, social isolation, and reduced physical activity.

This study compared lifestyle restrictions for 45 patients with diabetic retinopathy with an average age of about 67. Nearly 70 percent had worse than 20/60 vision in the better eye and the rest had worse than 20/40. All filled out standard questionnaires aimed at measuring the impact of their vision loss on their ability to participate in normal life activities. The median length of time patients had suffered from vision loss was two years.

Results show vision loss stemming from diabetic retinopathy had the biggest impact on reading print, mobility, work, and leisure. Vision loss had a lesser effect on emotional reaction to vision loss and household and personal care areas.

The authors say programs designed to help diabetic retinopathy patients deal with their loss of vision could improve quality of life for these patients. They write, “Based on our findings, low-vision rehabilitation services with programs aiming to improve outdoor mobility, print reading, participation in leisure activities, and psychological health could be an effective strategy to help individuals with DR increase their participation in activities of daily living.”

SOURCE: Archives of Ophthalmology, 2003;2004;122:84-88

New Stent Provides Better Results (January 15, 2004) 

(Ivanhoe Newswire)

Incorporating an anti-clotting agent into a metal stent used to hold open the arteries in patients who have undergone balloon angioplasty can help patients avoid reblockages. This would reduce the need for more surgery to remove those reblockages.

Researchers across the country enrolled about 1,300 patients in their clinical trial. About half the group received a bare metal stent and the other half received a stent that had been developed with a slow-release, polymer-based, paclitaxel-eluting agent. Paclitaxel is actually a cancer drug that, in lab studies, has shown potential to reduce reblockages of arteries.

Patients were followed for nine months. Results show those who received the special stents were significantly less likely to show signs of reblockage and less likely to need more treatment to clear new blockages. Compared to those who received the bare metal stent, these patients had a 70-percent relative reduction in the risk of reblockage on an angiography and a 73-percent reduction in the risk of target-lesion revascularization. Patients in the treatment group also had less need for coronary artery bypass surgery.

Reblockage after balloon angioplasty is common, and even when a stent is used, some patients develop another blockage that must be cleared again. Diabetic patients are at especially high risk for reblockages. In addition to the other findings, this study also shows a marked reduction in reblockages among diabetics who received the new stent, to the point where their risk for a reblockage was the same as that for patients without diabetes. By contrast, diabetic patients in the bare metal stent group had about a 50-percent increased risk of reblockage when compared to those without diabetes.

SOURCE: New England Journal of Medicine, 2003;350:221-230

Ephedra + Caffeine = Heart Problems (January 12, 2004) 

(Ivanhoe Newswire)

A new study shows dietary supplements that contain ephedra and caffeine may increase blood pressure and affect heart rhythms.

Researchers from the University of Connecticut School of Pharmacy studied 15 volunteers who received the dietary supplement Metabolife 356, which contains both ephedra and caffeine. Participants received either doses of Metabolife or a placebo for their first treatment. After a week off, participants returned for the second phase of the study and were given whichever treatment they did not receive the first time.

Results of the study show 53 percent of participants had their QTc intervals increase at least 30 seconds while taking the dietary supplement. The QTc is determined by a mathematical formula for heart beats/minute. A longer QTc interval can increase a person’s risk of developing an abnormal heartbeat.

Participants who received Metabolife also had a higher systolic blood pressure than those on the placebo. The average systolic blood pressure for those on the supplement was 123.5 millimeters/mercury, as opposed to 118.93 millimeters/mercury for those on placebo.

Authors of the study conclude, “The ephedra- and caffeine-containing dietary supplement Metabolife 356 increased the mean maximal QTc interval and systolic blood pressure ... Patients should be instructed to avoid this and similar dietary supplements until more information is known about their safety.”

SOURCE: Journal of the American Medical Association, 2004;291:216-221

High Birth Weight Associated with Asthma (January 13, 2004) 

(Ivanhoe Newswire)

A new study finds an association with a high birth weight and the risk of asthma. The study finds babies who weighed more than 9.9 pounds at birth are at a greater risk for asthma.

Childhood asthma is a chronic condition that has been increasing in prevalence and severity particularly among those younger than 5 years old. In fact, between 1987 and 1997, there was a 57 percent increase in the asthma hospitalization rate among those younger than 5. During this same time, there has been a substantial increase in the birth weight of babies and an increased incidence of obesity. But few studies have examined the relationship between birth weight and asthma.

University of Alberta researchers recently completed a study looking at the association between birth weight and asthma. For the study, authors included all babies born at term between April 1985 and March 1988. They divided the babies into three groups. The low group included babies less than 5.5 pounds, the normal group included babies between 5.5 pounds and 9.9 pounds, and the high group included babies who weighed more than 9.9 pounds. They then tracked the children for 10 years to see who had an emergency visit to the hospital for asthma.

Study authors report the babies born with a high birth weight had a significantly increased risk of an emergency room visit for asthma during childhood compared to the babies born with a normal birth weight. Researchers also found the more the child weighed as a baby, the more chances they had of visiting the emergency room for asthma. The study also found other factors associated with an elevated risk for an asthma visit including if the child was male, aboriginal status, and had a low-income family status.

Since heavy babies tend to remain overweight through childhood, researchers say this study reveals that obesity promotes inflammation and imposes mechanical constraints to the airways for children. They say children born with a high birth weight have close to a 20-percent increased-probability of asthma in the first 10 years of their lives than children born with a normal birth weight. Furthermore, for every three-ounce increase in birth weight above 9.9 pounds, there is an additional 10-percent increase in the probability of having an emergency visit to the hospital for asthma. Therefore, researchers say a high birth weight is an important risk factor for childhood asthma.


SOURCE: Archives of Pediatric Adolescent Medicine, 2004;158:60-64

Low-Tar Cigarettes Dangerous (January 12, 2004) 

(Ivanhoe Newswire)

A new study shows the risk for lung cancer is the same for people who smoke medium-tar cigarettes, low-tar cigarettes, or very-low-tar cigarettes.

Addicted smokers sometimes switch to lower tar cigarettes in hopes of continuing with their habit and hoping to not experience the consequences of higher tar cigarettes.

Researchers sampled nearly 364,000 men and 577,000 women and studied the relation between the tar rating in the cigarettes they smoked in 1982 and death from lung cancer over six years.

Those who smoked very-low-tar (7 milligrams or less) and low-tar (8 to 14 milligrams) cigarettes faced the same risk of lung cancer as smokers who used medium-tar (15 to 21 milligrams) brands. Factors such as demographics, diet, occupational and medical histories did not affect the data.

People who smoked non-filtered cigarettes with tar ratings of 22 milligrams or more had higher risks of lung cancer.

Researchers concluded that people who smoked any brand of tar cigarettes faced a higher risk of lung cancer than those who had never smoked or who had quit.

Reducing the use of high-tar, non-filter cigarettes may have limited health benefits in countries like China, France and Eastern Europe, where they are more commonly used and make up to 20 percent of cigarette sales. Non-filter cigarettes make up less than 1 percent of sales in the United States and United Kingdom.

SOURCE: British Medical Journal, 2004;328:1-8

Better Breast Exam (January 12, 2004) 

PORTLAND, Ore. (Ivanhoe Newswire)

Research shows a thorough breast exam takes five minutes to 10 minutes, and women themselves find more than 80 percent of all cancerous lumps. The problem is many women don’t know how to perform an effective self-exam and many doctors aren’t as thorough as they should be. The proper technique can make all the difference.

Several times a month Jean Ashby trades in her business suit for a hospital gown. She acts as a patient. She helps clinicians learn how to accurately look for breast cancer. “My best friend got it about four years ago,” Ashby tells Ivanhoe. “I knew that it was my reason, my mission, to help in any way I could.”

The new technique, called vertical strips, has clinicians examine the breast as a rectangle, instead of using the standard circular method. “If you were going to mow your lawn, that is a pentangle, or a rectangle, you wouldn’t mow it in circles, you would mow it in strips,” says Nancy Prouser, MS, a training program manager at Oregon Health & Science University in Portland.

Clinicians start with a synthetic breast model, learning to examine every cubic inch of tissue, using light, medium and deep pressure, never lifting their fingers to make sure they find any lumps. Then, comes the real test -- an actual person like Ashby. “Basically, I learn to give them feedback as to whether they’re making dime-sized circles, whether they’re spiraling down all the way to the chest wall,” she says.

Most lumps are benign, but the earlier a cancerous lump is detected, the more likely that cancer can be cured.

About a dozen state health departments and medical centers in the United States teach the vertical strips method. A private company called MammaCare also teaches it.

If you would like more information, please contact:
Nancy Prouser, MS
OHSU Cancer Institute
prousern@ohsu.edu

Accurate Blood Pressure Reading (January 12, 2004) 

(Ivanhoe Newswire)

A new study shows the way a patient’s arm is positioned affects the results of blood pressure readings.

Researchers from the University of California, San Diego School of Medicine, and the Medical College of Wisconsin studied 100 patients who had their blood pressure measured six times. Researchers took measurements while the patients employed perpendicular and parallel arm positions while lying, sitting and standing. A parallel arm position involves extending the arm in the same direction as the body, and a perpendicular position requires the elbow to make a right angle with the body. Researchers recorded the patients’ average systolic (top number) and diastolic (bottom number) measurements at different arm positions.

Results of the study show blood pressure readings taken when arms are parallel are up to 10-percent higher than readings taken when arms are perpendicular. Authors of the study write, “In every body position, the systolic and diastolic blood pressure measured with the arm perpendicular to the body was significantly lower than with the arm in a parallel position.”

Previous studies have shown more than 70 percent of health care workers do not use proper arm positions when taking blood pressure readings. The American Heart Association defines a correct position as a slightly flexed elbow held at heart level. Researchers say because blood pressure values determine treatment options, a correct measurement is vital to patients’ health care. Authors of the study conclude that a designated and consistent arm position should be adhered to when measuring blood pressure.


SOURCE: Annals of Internal Medicine, 2004;140:74-75

Help for Hip Joints (January 12, 2004) 

DURHAM, N.C. (Ivanhoe Newswire)

For decades, hip replacement surgery has been the only treatment for a deteriorated hip joint. Now a lasting procedure for some younger patients may replace the traditional replacements.

Bobby Castor plays on his school’s golf team. But a broken hip in grade school led to a condition called avascular necrosis. Decreased blood flow caused his hip joint to die. Since the hips drive a golf swing, it hurt Castor’s game. “I was just limping around the course and just kind of being in a constant state of pain for almost half the day. It was hard to deal with,” he tells Ivanhoe.

So, Castor took advantage of a new procedure developed by Duke University doctors called a free vascularized fibular graft. They take a piece of the bone from the lower leg, insert it into a hole drilled into the hip joint, and connect the blood vessels on the other end.

“The new blood circulating causes new bone to grow. So, in effect, we’re trying to bring the hip bone back alive,” says Duke University orthopedic surgeon James Urbaniak, M.D.

So far, the procedure has an 80-percent success rate. Dr. Urbaniak says, “I think the biggest advantage is, if it works well and we catch the disease early enough, it can last the patient’s lifetime.”

“This is really gonna prolong my quality of life quite a bit,” Castor says, and the quality of his game, since eliminating his physical handicap will help cut his golf handicap, too.

Dr. Urbaniak says this procedure is currently only used for younger patients with avascular necrosis. He also adds that removing a section of the bone from the lower leg for the graft has no negative effect, since it is not a weight-bearing bone.

If you would like more information, please contact:
Richard Merritt
Senior Medical News Writer
Duke University Medical Center
(919) 660-1309
merri006@mc.duke.edu

Different Types of Asthma (January 12, 2004) 

(Ivanhoe Newswire)

The age a person develops asthma may help explain their disease more clearly. A new study finds people who are diagnosed with asthma as children have a different disease than those who develop it as an adult. Researchers say the patients suffered different symptoms and disease progression based on the age of onset.

Eighty patients with severe asthma that could not be controlled by steroids participated in the study. They were divided into two groups including those diagnosed before 12 years old and those who developed the disease later in life. The participants were evaluated for differences in allergic response, symptoms, lung function and pathology.

Lead study author Sally Wenzel, M.D., a pulmonologist at National Jewish Medical and Research Center in Denver, says: “We found that patients whose asthma began in childhood were more frequently allergic than those whose asthma began as adults, while adult-onset asthma was associated with more rapid loss of lung function. We were surprised to find that many patients showed no signs of inflammation, generally considered a hallmark of the asthma, yet they still had severe airflow limitation and many asthma symptoms.” Specifically, researchers say more than 75 percent of patients who developed asthma before 12 say they wheezed most or all of the time when exposed to dust or pollens. In contrast, only 40 percent of patients diagnosed after 12 reported the same scenario.

Even though the early onset patients had had the disease for a longer period, researchers found the lung function was worse in the adult-onset group. This suggests patients diagnosed later suffer a more rapid loss of lung function. The study also found late-onset patients were more likely to have inflammatory cells known as eosinophils in their airways, despite treatment.

Researchers say it is clear asthma is not a single disease, but a group of syndromes with different origins and biological characteristics. They hope defining these subsets will help in asthma diagnosis, treatment and future research.

SOURCE: The Journal of Allergy and Clinical Immunology, 2004;113:101-108

Protein Linked to Miscarriage (January 9, 2004) 

(Ivanhoe Newswire)

Approximately 10 percent to 15 percent of pregnancies end in a miscarriage. Currently there are no treatments to prevent a miscarriage and no markers to identify women at high risk for one. However, a new study shows low levels of a protein involved in the immune system could be a potential indicator for a miscarriage.

Macrophage inhibitory cytokine 1 (MIC1) plays an important part in the immune system and is found in high concentrations between a mother and her fetus during pregnancy. Researchers in Australia investigated whether the levels of MIC1 are associated with a miscarriage.

The research included 300 pregnant women who gave a blood sample during the first trimester of pregnancy. Researchers say 100 of the women miscarried and the other 200 women did not. Investigators report the MIC1 levels were about one-third lower among the women who miscarried compared to the women who did not. They also found no difference in the levels in relation to the timing of the miscarriage. However, they say in most cases low MIC1 concentrations preceded miscarriage by several weeks.

Researchers say, while it is tempting to speculate that changes in MIC1 is part of the mechanism that causes a miscarriage, it’s too early to draw that conclusion. However, they feel if a causal link between MIC1 and miscarriage is confirmed, this might be useful in the prevention of miscarriage.

In an accompanying commentary, researchers from Israel say if the measurement of MIC1 could predict miscarriage, this could be a useful tool for the medical community. However, they also feel that the crucial question is whether the decrease in concentrations of MIC1 is connected to the pathological processes of a miscarriage. But they add if the results of this study can be confirmed, then this could lead to new therapies to prevent pregnancy loss.


SOURCE: The Lancet, 2004;363:129-130 and 96-97

BMI Standards Different for Asians (January 9, 2004) 

(Ivanhoe Newswire)

New research shows the standards for body mass index (BMI) when defining overweight and obesity may not be appropriate for some Asian populations. The study shows lower BMI levels could have health benefits for Asians.

The World Health Organization (WHO) set up classifications for overweight and obesity meant for international use. The cut-off points reflect a higher risk for type 2 diabetes and cardiovascular diseases. But research is showing there is an increase in prevalence of type 2 diabetes and increased cardiovascular factors in parts of Asia where the average BMI is below the cut off point. A WHO expert consultation led by a professor at the University of Pennsylvania School of Medicine looked at the merits of BMI as an indicator of health outcomes across different ethnic populations.

For the study, researchers reviewed data that suggested Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. They found that this information is correct. Researchers report the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing cut off point for overweight. However, study authors say current research does not make it clear what the cut off point for Asians should be to adjust for this health risk.

While study authors agreed that the current BMI cut off points should be maintained for now, they say further research is needed on specific ethnic groups. Furthermore, they say methods by which countries could make decisions about the definitions of increased risk for their population need to be established.

SOURCE: The Lancet, 2004;363:157-163

Gender Difference in Insulin Resistance (January 9, 2004) 

(Ivanhoe Newswire)

Type 2 diabetes is a major world health concern. It used to be considered an adult disease, but now more children are being diagnosed with type 2 diabetes. Research has shown girls are affected more than boys. Now, a new study shows sex-linked genes may explain this difference between girls and boys being diagnosed with type 2 diabetes.

Study authors from the University of Dundee in the United Kingdom are conducting the EarlyBird study. The EarlyBird study aims to establish which children are insulin-resistant and why. The study included 307 healthy children 4 or 5 years old who will be followed until they are 16 years old. Researchers are keeping track of each child’s height, weight, physical activity, resting energy expenditure, and insulin resistance.

Researchers have found, at 5 years old, insulin resistance was 35-percent higher in girls than in boys. The study also shows girls had 26-percent more fat despite similar body weights. However, after adjusting height and weight variables and physical activity, girls remain 33-percent more insulin-resistant than boys. Researchers also found triglycerides were significantly higher in girls and good cholesterol was lower in girls than in boys.

Investigators say this study shows evidence that prepubertal girls are intrinsically more insulin-resistant than boys. Researchers suggest sex-linked genes may explain this difference but the nature of these genes remains unclear.

SOURCE: Pediatrics, 2004;113:82-86

Controlling High Blood Pressure (January 5, 2004) 

CELEBRATION, Fla. (Ivanhoe Newswire)

In May 2003, new guidelines were released that lowered normal blood pressure to a reading of 120/80 millimeters of mercury. Anything higher can significantly raise the risk of heart disease. Here are some steps to take and facts to know to keep your pressure down.

Nearly 60 million Americans have high blood pressure. “If a person is on a medicine and thinks their blood pressure is under control, they may be sadly mistaken,” says cardiologist James Rippe, M.D., of Rippe Health Assessment at Florida Hospital/Celebration Health in Celebration, Fla. He says more than half of those who take medication are not controlled.

The new norm is 120/80 mm Hg, which was lowered last year, Dr. Rippe says, for good reason. “For every 20 millimeters of mercury systolic -- that’s the higher number -- that you increase, or 10 millimeters diastolic, the lower number that you increase, you double your risk of heart disease.”

Exercising 30 minutes a day, limiting salt, and more calcium and potassium can lower blood pressure.

And these tips aren’t just for the average Joe. Just ask football hall-of-famer Joe Montana. “He said my blood pressure was extremely high, and I should do almost like the Monopoly game, ‘Please go directly to jail. Do not pass go. Go straight to the cardiologist,’” Montana tells Ivanhoe.

His blood pressure used to be off the charts. Montana says: “As an athlete, you spend so much time being active, that it almost doesn’t matter what you eat or it doesn’t feel like it does, but you can’t continue those habits after you retire. I found that out.”

Like many people, Montana’s medication wasn’t enough. He uses a combination drug to keep his pressure down. His message is simple. “If you’re on medication, you should still make sure you’re being checked because that medication may not be enough, as it was in my case,” he says.

With his blood pressure under control, Montana can now face the next phase of his life -- with his health in check.

If you would like more information, please contact:
American Heart Association
http://www.americanheart.org
Take the Pressure Off
(877) GET-BP-DOWN
http://www.takethepressureoff.com

Nitric Oxide for Preemies (January 5, 2004) 

CHICAGO (Ivanhoe Newswire)

Each year, about 60,000 babies are born prematurely, meaning they are born more than three weeks before their due date. Those little bodies often mean big health problems, but a new therapy may let little ones, and their parents, breathe a big sigh of relief.

Jorge Ramos, his wife Linda, and their daughter Sara look like any other family of three. “It’s the best thing,” Linda says. “There’s nothing better than being a mom, I can honestly say.” Jorge says: “It gives you a reason to live. You come home. You have something to look forward to.”

But Sara’s entry into the world was quite an event. She was born three months early and weighed less than two pounds. This was her first dress, her first diaper, and her first bathtub was a butter tub.

“I didn’t realize all the complications that were involved. I didn’t realize all the risks,” Linda says.

One of those risks is lung disease, a common condition in preemies. “It leads to an increased likelihood of developing asthma, an increased susceptibility to infections, and severe chronic lung disease can be associated with poor brain function later on,” says neonatologist Michael D. Schreiber, M.D., of University of Chicago Children’s Hospital.

Sara received an investigative treatment of nitric oxide that Dr. Schreiber was studying to reduce lung disease in preemies. He says, “Nitric oxide is an anti-inflammatory, and inflammation plays a major role in the development of chronic lung disease.”

A recent study shows a continuous dose of nitric oxide for one week reduced the risk of lung disease in preemies by 25 percent and reduced brain bleeds -- another common risk -- by nearly 50 percent. Dr. Schreiber says, “I think it’s one more tool that the neonatologists will have to help improve outcomes for these tiny little babies.”

It worked for Sara. Linda says, “We’ve had everything good, all good turnouts, and you can’t ask for more than that.”

Three different studies of nitric oxide are currently ongoing. Dr. Schreiber hopes these studies will clarify which preemies will benefit most from nitric oxide. If studies confirm the effect, he says doctors could use nitric oxide as an off-label treatment almost immediately in preemies, since it’s already approved for full-term infants. However, it could take at least a year to petition the FDA to approve it specifically for preemies.

If you would like more information, please contact:
Karyn Odway
Media Relations Specialist
University of Chicago Hospitals
(773) 702-6241
kodway@uchospitals.edu

Lizard Saliva for Diabetes (January 5, 2004) 

CHAPEL HILL, N.C. (Ivanhoe Newswire)

New statistics show about 18 million Americans have diabetes, and even with medication, many have trouble controlling it. Now there is a treatment from an unlikely source that could offer a better way to manage the disease.

The Gila monster is a rare lizard with deadly venom in its saliva. That turns out to be a good thing for type 2 diabetics like Bill Caldwell. “It’s wild. Only in America,” he tells Ivanhoe.

Researchers have used the saliva to develop a new drug called exenatide. It’s injected twice a day to help type 2 diabetics keep their blood sugar under control.

“We think that the effect of the drug has something to do with the fact that this animal eats two, maybe three or four times a year,” says diabetologist John Buse, M.D., Ph.D., of UNC Diabetes Care Center in Chapel Hill.

A hormone in the lizard’s saliva slows its metabolism between meals and keeps its blood sugar low when it does eat. It seems to have the same effect on patients with type 2 diabetes.

Caldwell was part of a study using exenatide. He says, “I did find that my numbers came down. I did find that the drug, the medication, could help me.” Like most patients in the studies, he also experienced modest weight loss.

“That’s pretty rare for a diabetes drug. Most diabetes drugs are actually associated with weight gain,” Dr. Buse says. That’s good news since about 80 percent of type 2 diabetics are overweight. Researchers also say exenatide could reduce the need for insulin in type 2 diabetics. “This is a remarkably effective drug,” Dr. Buse says.

And Caldwell doesn’t care where it comes from. He says, “Hey, whatever works, if it’s tree bark or ants, if it works.”

Since Gila monsters are at risk of becoming an endangered species, exenatide is now made synthetically and not from the lizard. Researchers say it will take at least a year before the FDA approves the drug.

If you would like more information, please contact:
Stephanie Crayton-Robinson
Media Relations Manager
UNC Healthcare
(919) 966-2860
scrayton@unch.unc.edu

Potential Treatment for Alcohol Abuse (January 1, 2004) 

(Ivanhoe Newswire)

New research provides a novel and promising way to treat patients who are dependent on alcohol. The study shows blocking selected neurotransmitters in the brain can reduce both the onset as well as the repetition of alcohol consumption.

Neuropeptide Y (NPY) is the most abundant and widely distributed peptide. Peptides are a class of neurotransmitters, chemicals used by brain cells to communicate with each other. NPY is involved in a variety of functions including anxiety, pain, memory and feeding behavior. While previous research has linked NPY systems in alcohol abuse and alcoholism, the new study is thought to be the first to show that a compound that blocks NPY activity may be useful for alcohol treatment.

The research was conducted on mice. Study authors used alcohol-preferring mice to examine the effects of the NPY-Y5 receptor antagonist called L-152,804 on the onset and maintenance of alcohol self-administration. Fifty-nine mice were in standard cages with free access to food and water. The mice were taught to self-administer either alcohol or water. After four months, the mice were injected with L-152,804 prior to sessions.

Researchers report the L-152,804 delayed the onset of alcohol self-administration. This is considered an index of relapse potential. The study also found the L-152,804 reduced the reinforcing or rewarding effects of alcohol. "The process by which drug self-administration behavior becomes repetitive is called positive reinforcement," says Clyde W. Hodges, study author and associate professor in the department of psychiatry and pharmacology at the University of North Carolina at Chapel Hill. He says, "It reflects the tendency of all animals, human and non-human, to repeat responses that produce a desired outcome."

Clyde concludes, "These results suggest that L-152,804 might reduce the motivation to start drinking as well as decrease the amount of alcohol consumed. Thus, L-152,804 might make relapse less likely and possibly dampen its consequences."

SOURCE: Published in this month's issue of Alcoholism: Clinical & Experimental Research, Dec. 2003

Partial Breast Reconstruction