Future of Fibromyalgia (August 29, 2003) 

SEATTLE (Ivanhoe Newswire)

Fibromyalgia is a condition characterized by extreme pain and muscle stiffness. It strikes 5 million to 10 million Americans. Fibromyalgia is often treated with anti-depressants, but newer, more targeted therapies may soon be available.

For more than 20 years, Elizabeth Tross-Deamer suffered the pain of fibromyalgia. She started taking a new medication -- pregabalin -- and her pain subsided. “The memory is better. My relationships are better," she says. "People like me a lot more." For the first time in years, this wine author can sleep at night, giving her back energy and stamina during the day.

Bernadine Smith took a different drug -- milnacipran -- and had similar results. She says: “I didn’t have as much depression. I wasn’t as fatigued.”

Rheumatologist Philip J. Mease, M.D., is testing both drugs in separate studies. “At least a third of the patients in both trials have experienced, roughly, a 50-percent reduction in pain,” he says. The drugs come from different families -- pregabalin is a pain reliever, milnacipran an anti-depressant.

Dr. Mease, of Swedish Hospital Medical Center in Seattle, says, “What both of these medications are doing are restoring to a more natural balance the neuro-chemicals in the brain that are off kilter in this condition.”

Both drugs are still in trials, but for these two women, the verdict is already in.

The most common side effects in the pregabalin trial were mild dizziness, which went away as drug use continued. For milnacipran, it was nausea. Pregabalin could be approved next year. Milnacipran will likely be approved in two years.

If you would like more information, please contact:

Pfizer, Inc.
http://www.Pfizer.com

Drug Effective for Vascular Dementia (August 29, 2003) 

(Ivanhoe Newswire)

Researchers studying a potential new drug for vascular dementia find it can help treat the cognitive impairment typical of the condition.

Vascular dementia -- or VaD -- is usually associated with cardiovascular disease. About 15 percent to 20 percent of all cases of dementia are attributed to VaD. Unlike Alzheimer’s disease, which robs people of their cognitive abilities slowly over time, VaD often strikes quickly, such as after a stroke. However, studies show similarities between Alzheimer’s and VaD, particularly in terms of a cholinergic (nerve fiber) deficit, leading researchers to believe VaD patients may also benefit from treatment with cholinesterase inhibitors. Cholinesterase inhibitors are often used in the treatment of Alzheimer’s.

In this study, investigators studied the effect of the cholinesterase inhibitor donepezil on people with a probable or possible diagnosis of VaD. About 600 patients with an average age of 75 took part in the study. Patients were randomized to receive the drug in one of two doses -- five milligrams once a day or 10 milligrams once a day -- or a placebo, for 24 weeks. Patients on the higher dose first took the lower dose for about a month.

Results showed both of the active drug groups had improvements in cognitive function as measured by standard tests when compared with those who received the placebo. The 10-milligram per day dose resulted in additional treatment benefits on a test aimed at measuring dementia severity. The drug was also well tolerated, causing few unwanted side effects among those who received it.

SOURCE: Neurology, 2003;61:479-486

Better Drug for Heart Transplant (August 29, 2003) 

(Ivanhoe Newswire)

A new study shows the drug everolimus is better at reducing problems in heart transplant patients than one of the currently used drugs. Specifically the drug reduced the incidence of a serious disorder that can cause deterioration of the graft known as coronary vasculopathy.

Previous studies have shown everolimus combined with another drug reduced the rejection and risk of infection in kidney transplant patients. Researchers from Temple University in Philadelphia conducted a study to determine if everolimus is also effective for heart transplant patients.

For the study, 634 patients were randomly assigned to receive one of two doses of everolimus or another drug, azathioprine, after having a heart transplant. The drugs were given once a day in combination with other standard treatments. Researchers followed patients for one year to determine if they had any complications from the transplant.

Researchers report the patients on either dose of everolimus fared much better than the patients on azathioprine. After one year, researchers say it was clear everolimus was significantly more effective than azathioprine in preventing vasculopathy. Study authors write, “Everolimus combined with cyclosporine and corticosteroids during the first 12 months is a safe and effective immunosuppressant regimen for use in recipients of a first heart transplant.”

Researchers say further evaluation and follow-up are needed to determine the optimal dose. However, they say the findings of this study offer some optimism that everolimus is a promising agent for the management of rejection and vasculopathy after heart transplantation.

SOURCE: New England Journal of Medicine, 2003;349:847-858

Chemotherapy Effective for Bladder Cancer (August 28, 2003) 

(Ivanhoe Newswire)

A combination treatment helps patients with bladder cancer live longer, according to a new study. The research shows patients who receive chemotherapy plus surgery survive longer than patients who only have surgery. Doctors call this an important advance in the treatment of this deadly disease.

Bladder cancer is the fourth most common cancer in men and the eighth most common cancer in women. According to the American Cancer Society, approximately 57,000 people will be diagnosed with bladder cancer in 2003 and 12,500 will die of the disease. Investigators at the University of Texas M.D. Anderson Cancer Center conducted a study to determine if chemotherapy plus surgery could help patients live longer.

The study included 154 patients who received surgery only and 153 patients who had chemotherapy before having surgery. Researchers looked at the overall survival of the patients in both groups over 11 years.

Researchers found patients treated with surgery alone lived 41 months compared to 77 months in patients who had the combination treatment. Specifically, 77 patients in the surgery only group died and 54 patients died in the group receiving chemotherapy. Patients who had surgery only had a 66-percent greater risk of dying from bladder cancer than those who received the combination therapy. Researchers say 10 years after treatment, some of the patients in the combination therapy group are still alive, and therefore the treatment provided a cure for them.

Researchers say treatment for bladder cancer varies across the country, but they believe a combination approach should be used more often for patients with locally advanced bladder cancer. They believe this study shows chemotherapy plus surgery is more effective at eliminating the cancer and is associated with improved survival.

SOURCE: New England Journal of Medicine, 2003;349:859

Low-Dose Hormones Help the Bones (August 27, 2003) 

(Ivanhoe Newswire)

Osteoporosis is a major cause of disability in older women. Estrogen therapy is often prescribed to prevent osteoporosis. However, many women are reluctant to take hormone therapy because of the increased risk of breast cancer, heart disease, stroke and deep vein blood clots. Now, new research finds a lower dosage of estrogen increases bone density in women without possibly causing the problems typically associated with the standard dose of estrogen therapy.

For the study, researchers from the University of Connecticut investigated the effects of one quarter of the dose of estrogen typically prescribed for conventional hormone therapy. Researchers included 167 women older than 65 in the study. The women were randomly assigned to receive the smaller amount of estrogen or placebo. Researchers measured the bone mineral density of the hip, spine, wrist and the total body every year for three years. They also looked at markers for bone resorption and bone formation during the study.

Researchers found women who were on the low dose of estrogen had an increase in their bone mineral density at all the sites measured compared to women on the placebo. They found the markers for bone loss were also significantly decreased in women taking the low-dose estrogen compared to the placebo group. Furthermore, researchers report the number of adverse effects was similar in both groups.

Study authors conclude these results show a low dose of estrogen is effective at preventing bone loss. They hypothesize that lowering the dose of estrogen may also reduce the number of adverse events.

SOURCE: Journal of the American Medical Association, 2003;290:1042-1048

Kidney Patients Protect Their Hearts (August 27, 2003) 

NEW ORLEANS (Ivanhoe Newswire)

More than 20 million Americans have chronic kidney disease, and more than 378,000 thousand Americans suffer from chronic kidney failure, requiring dialysis to stay alive. With kidney failure also comes risk to the heart. Doctors from the Veterans Affairs Medical System hope to reduce that risk and keep patients living longer.

Theodore Chriss spent 15 of the best years of his life in the Navy. “I loved it in the Navy," he tells Ivanhoe. "We seen a lot of fighting over there in Vietnam.” Now, he’s in a different fight. Health problems have snuck up on him like an enemy submarine. “You can’t see them, but they’re there. I wound up with glaucoma, and I had a stroke in one eye. I had open-heart surgery.”

Then, came Chriss' most recent battle. “They told me that my kidneys were disintegrating.”

He has chronic kidney failure. The condition increases the risk of heart disease, heart attacks, and stroke. Doctors think one culprit may be a substance in the blood called homocysteine. Normal levels are four to 12 per milligram.

VA Medical Center nephrologist Albert Dreisbach, M.D., says, “Patients may have levels of 15 or 20 or, in advanced renal failure, 50 or 60.”

Now, doctors at the VA have embarked upon a $20 million study to reduce homocysteine levels -- with vitamins.

“There’s no medication that I know of that can lower homocysteine levels,” says Dr. Dreisbach. Now, doctors hope vitamins B-12 and B-6, along with folic acid may. Patients take high doses to reduce their risk of heart disease.

Chriss takes the vitamins every day. He thinks it’s helping, but he still prefers his own medicine. “The best medicine you have is a smile," he says, "and if somebody don’t have a smile, I always give them one of mine.”

The study is being conducted at 36 VA centers across the country. It will stop enrolling in September this year. The doses of the vitamins are extremely high -- from five- to 100-times the recommended dose -- but doctors say there are no negative side effects from these doses. If you want more information on how to enroll, call your local VA center.

If you would like more information, please contact:

Fran Simon
Public Relations Director
Tulane University Health Sciences Center
(504) 588-5221
fsimon@tulane.edu

Diabetes may Impair Driving Ability (August 26, 2003) 

(Ivanhoe Newswire)

People with type 1 diabetes may be more likely than healthy people or people with type 2 diabetes to end up in a motor vehicle accident, report investigators publishing in this month’s Diabetes Care.

Researchers say the intense treatment people receive for the condition puts them at higher risk for hypoglycemia, or low blood sugar, which can result in a stupor-like state that seriously affects the individual’s ability to follow the rules of the road.

The study was conducted among type 1 diabetics, type 2 diabetics, and their non-diabetic spouses during routine checkups at diabetic clinics in the United States and Europe. All participants filled out detailed questionnaires concerning diabetes and driving. There were about 350 people in each of the three groups.

Results showed people with type 1 diabetes reported significantly more car accidents, moving violations, episodes of hypoglycemic stupor, incidents requiring assistance, and mild hypoglycemia while driving than those with type 2 diabetes or the non-diabetic spouses. Interestingly, say researchers, type 2 patients scored about the same as non-diabetic spouses.

Further analysis linked car crashes among type 1 diabetics with more frequent episodes of hypoglycemia, less frequent blood glucose monitoring before driving, and the use of insulin injection therapy as opposed to pump therapy.

Authors believe these findings serve to indicate the potential need for preventative steps to be taken to reduce the risk of possible crashes for drivers with type 1 diabetes.

SOURCE: Diabetes Care, 2003;26:2329-2334

Benefit of Nurse Interventions (August 25, 2003) 

(Ivanhoe Newswire)

It appears from a new study that adding nurse interventions to treatment improves outcomes for patients. A new study shows specialist nurse-led clinics were associated with a significant improvement in diabetic patients after one year.

Participants with high blood pressure were randomized to the specialist nurse-led hypertension clinic or usual care. Participants with raised total cholesterol were randomized to the specialist nurse-led hyperlipidemia clinic or usual care. Sessions for the patients who received nurse interventions were used to discuss individual targets for treatment and lifestyle factors, such as diet, alcohol and exercise, all which can contribute to or affect response to treatment. An accurate assessment of each individual's condition was made and an individualized education program was implemented, which included the risks of hypertension or dyslipidemia, treatment benefits, lifestyle changes, drug actions and potential side effects. The sessions lasted from a half hour to 45 minutes and continued for four to six weeks.

Results of the study show overall 37 percent of patients who received the interventions achieved their target goals compared to 30 percent in the usual care group. In the cholesterol group who received intervention, 53 percent of patients achieved their cholesterol targets compared to 40 percent in the standard care group. In the blood pressure group, 26 percent of patients who received interventions achieved their targets while 24 percent in the standard care group reached their targets.

Of the 1,407 patients in the trial, 778 received interventions and 629 received standard treatment. There were 25 deaths in the intervention group compared to 36 deaths in the standard care group. Researchers stress the importance of clinicians' awareness and application of the best evidence available for treatment to assure quality health care.

SOURCE: Diabetes Care, 2003;26:2250-2255

Carotene, vitamin E don't prevent heart attacks (August 25, 2003) 

(Reuters Health)

Having high levels of vitamin E or beta-carotene (and compounds like it) is no guarantee that you won't have a heart attack, new research shows. In fact, high levels of one type of vitamin E -- known as gamma-tocopherol -- may actually increase the risk.

Because these chemicals are antioxidants, it has been thought that they may protect against the formation of plaque that can block arteries, by preventing the oxidation of LDL ("bad") cholesterol. Although several studies have examined the link between beta-carotene and heart disease, relatively few have looked at the effects of other so- called carotenoids.

To look into the question, Dr. Jing Ma from Harvard University in Boston, and others, turned to the Physicians' Health Study, which began in 1982 and followed participants for up to 13 years. The researchers compared the levels of carotenoids and tocopherols in the blood of 531 men who later had a heart attack with those of a control group of 531 similar men who did not have a heart attack.

Blood levels of five major carotenoids were measured, as well as levels of retinol, alpha- tocopherol and gamma- tocopherol.

"Based on the antioxidant hypothesis, we expected people with high levels of these compounds to be at low risk for developing heart disease," Dr. Ma told Reuters Health. "But, this is not what we found."

Overall, there were was no evidence that the carotenoids or tocopherols protected against heart attacks, the team reports in the American Heart Association's journal, Circulation.
However, among current and former smokers, higher levels of beta-carotene did lower the risk of a heart attack.

On the other hand, high gamma-tocopherol levels were actually linked to an increased risk. But gamma-tocopherol itself may not actually be harmful, Ma noted. "Gamma-tocopherol may simply represent a marker for trans-fat intake," which is known to up the risk for heart disease.

"These findings should not discourage people from eating fruits and vegetables, as there are probably other components present that protect against heart disease," she stressed. "The bulk of evidence still supports a beneficial effect for eating such foods."

SOURCE: Circulation, August 19, 2003.

Early Detection of Lung Cancer (August 25, 2003) 

(Ivanhoe Newswire)

Health officials may be one step closer to a widespread screening policy aimed at detecting lung cancer in its earliest and most treatable phase.

If further studies confirm findings from Italian researchers, doctors may one day use a combination of spiral computed tomography and positron emission tamography scanning to uncover the cancer before it becomes more difficult to treat.

Lung cancer is the number one cause of cancer death worldwide, accounting for more than 1.3 million deaths a year. Since the disease is hard to detect in early and treatable stages, most cases are found only after the cancer has spread. Five year survival rates are low; in Europe, only about 10 percent of patients live that long. Studies have shown CT scans can identify the disease in an early stage in individuals considered at high risk for lung cancer, but they also identify many noncancerous lesions in the process.

In this study, researchers used PET scans to confirm findings from CT scans in more than 1,000 heavy smokers considered at high risk for lung cancer. All had annual CT scans for up to five years. As with previous studies of CT scanning for lung cancer, nodules were identified in a significant percentage of the group -- 29 percent. Most were small, and the protocol called for lesions up to five millimeters to be followed up with using another scan in a year rather than further treatment. Only 9 percent of the participants underwent further investigation of suspicious lesions using a higher-resolution CT scan with or without PET scanning. In this group, 23 percent were found to have lung cancer. Doctors were able to completely remove the cancerous tumors in 95 percent of the cases.

In an accompanying commentary, Stefan Diederich, from Marien Hospital in Dusseldorf, Germany, credits the Italian study with adding “an important aspect to the field of lung cancer screening.” He calls for additional study to see if regular scanning for lung cancer can reduce mortality from the disease.


SOURCE: The Lancet, 2003;362:593-597, 588

Alcohol and Sun Don’t Mix (August 25, 2003) 

(Ivanhoe Newswire)

New research suggests you may want to leave the alcohol at home next time you head to the beach. It may contribute to painful sunburn.

Researchers from the University of Texas Medical Branch in Galveston found those who consumed alcohol at the beach had more severe sunburns than nondrinkers and were more likely to need a pain reliever after the sunburn. Drinkers also had a significantly greater body surface area sunburned than nondrinkers and were more likely to develop blisters. However, drinkers did not report spending more time in the sun than nondrinkers. Investigators say alcohol use may blunt the immediate sensation of sunburn, which prevents subtle behavioral changes that could decrease further exposure to UV light and additional skin damage.

Sunburn could do more than cause pain. Sunburn can be a costly injury. Of the 38 respondents five men missed nine days of work and one woman missed eight days because of sunburn within the year before the study.

Based on these findings, researchers estimate sunburn may account for as many as 92,720 lost workdays by beachgoers in Galveston, Texas alone each year. The annual economic impact for lost work and treatment may exceed $10 million.

SOURCE: Archives of Dermatology, 2003;139:1003-1006

Artificial Finger Joints (August 25, 2003) 

NEW ORLEANS (Ivanhoe Newswire)

There were more than 400,040 total joint replacement procedures performed in 1999. Hip and knee replacements are the most common and account for 98 percent of joint replacement procedures. Arthritis is the common culprit when a joint is needed. Yet, arthritis affects more than just hips and knees. It’s also common in the hands and fingers. Now, doctors are replacing the smaller joints with more success. And they’re not just for arthritis patients.

Across the country, hip and knee replacements are routine, but smaller joint replacements have been more of a challenge.

“You’re using your fingers and your joints all day long, so you have to think that the wear or the breakdown may be higher, may be faster,” says Tulane University orthopedic surgeon Kathleen Robertson, M.D.

Now, these new artificial joints give people more mobility. They’re made of the same material used in heart valves.

“We know that after your heart beats many, many millions of times a year, that those valves have not worn out," Dr. Robertson says. "That’s where the idea of the actual metal for this implant came from was because of the long track record.”

Unlike typical silicone implants, the new implants withstand frequent wear and tear. Dr. Robertson says that’s crucial. “What you’re trying to give back to them is painless motion.”

They can help arthritis patients or patients who have suffered an injury, like Michael Smith, who nearly lost his finger to a saw blade. “It cut the bone completely in half, and it dropped the finger down to here. There was only a piece of skin right here holding it, holding it on," he tells Ivanhoe.

Doctors saved Smith's finger, but pain and limited mobility followed. The artificial joint helped. “It’s been a lot better," he says. "I have pain medicine, but I don’t take it unless I really have to.”

After 19 months of rehab, he’s gone back to his construction job. “I’ve heard stories about other people cutting themselves, and I just didn’t think it was going to happen to me. Be very careful when you’re cutting with power saws because it can happen to anybody.” With his new joint, Smith is sure to take his own advice.

Dr. Robertson says the best candidates for artificial joints are those who have osteoarthritis, a young person who has traumatic arthritis -- like Smith -- or a person who has early rheumatoid arthritis. The joints were recently FDA approved so any surgeon has the capability of using them.

If you would like more information, please contact:
Fran Simon, Public Relations Director
Tulane University
Health Sciences Center
(504) 588-5221
fsimon@tulane.edu

ACE Inhibitor May Lower Sudden Death Risk (August 22, 2003) 

(Ivanhoe Newswire)

Diabetics who also suffer from high blood pressure and an enlarged left ventricle may be able to lower their risk of sudden cardiac death if they take an ACE inhibitor drug for their condition rather than a beta-blocker drug.

That’s the finding from researchers who analyzed data from a previous study comparing the ACE inhibitor losartan with the beta blocker atenolol. In that study, published in The Lancet in 2002, the investigators found an overall lower death rate for diabetic patients with high blood pressure and an enlarged left ventricle (left ventricular hypertrophy) who took the ACE inhibitor when compared to those on the beta blocker. Since much of the difference was seen in cardiac deaths, they wondered how the ACE inhibitor might be impacting risk of sudden cardiac death, a known problem among diabetics with these conditions.

The new study looked at nearly 1,200 of the original participants in the earlier study, about half of whom received the ACE inhibitor and half of whom received the beta blocker. Results showed 44 patients succumbed to sudden cardiac death, 14 in the losartan group and 30 in the atenolol group. These findings translate to nearly a 50 percent reduction in the risk of sudden cardiac death for those taking losartan.

The investigators call for more study to confirm these findings. In an accompanying commentary, Wilbert S. Aronow, from Westchester Medical Center and New York Medical College, agrees, noting other beta blockers have been shown effective in other studies in reducing sudden cardiac death in other patients. He calls for additional studies comparing losartan to these other beta blockers in patients with diabetes, high blood pressure, and left ventricular hypertrophy.

SOURCE: The Lancet, 2003;362:591-592, 619-620

Reviving the Immune System (August 22, 2003) 

PHILADELPHIA (Ivanhoe Newswire)

Stem cell transplants have become an increasingly common procedure for hard-to-treat cancers. The goal is to restore the immune system. But it can take months or even years for stem cells to become immune cells, and during that time the patient is at risk for serious infection. Now, researchers have taken cell transplants one step further with incredible results.

This is no ordinary science lesson. Ed Bauter is getting a glimpse of the technology that saved his life. At 14, he was diagnosed with lymphoma. Doctors offered him an experimental treatment. “I didn’t think that I really had anything to lose doing a study," he tells Ivanhoe. "So, I went on with it, and it’s worked great so far.”

“What’s special about the process that we’ve developed is we activate the cells in a way that no one else had been able to do previously,” says immunologist Bruce Levine, Ph.D., of Abramson Cancer Center/University of Pennsylvania in Philadelphia.

Doctors remove white blood cells and bring them to the lab. Here, they’re multiplied and mixed with beads attached to a protein. When the new cells are put back into the body, they’re better able to attack foreign substances, like the cancer.

Levine says, “What we want to do is tilt the balance in favor of the immune system and away from the tumor or lymphoma.”

In a study of 16 patients, five went into complete remission, seven had partial remission, and four had their disease stabilize.

“Given that this was a very advanced, very ill population of patients, the responses that we saw were very encouraging for using this technique,” Levine says. And it’s gratifying to see it work for people like Bauter.

“With what I was diagnosed with 10 to 15 years ago, I would not have had a chance," says Bauter. Not only is he alive, he’s getting ready to start college in the fall.

This procedure is not just for lymphoma. Studies are also being done in patients with leukemia, myeloma, breast cancer, ovarian cancer, other solid cancers and HIV.

If you would like more information, please contact:

University of Pennsylvania
Referral Hotline
(800) 789-10-PENN

Diet for Epilepsy Raises Cholesterol in Children (August 21, 2003) 

(Ivanhoe Newswire)

A diet developed eight years ago to help manage seizures in children with epilepsy may significantly raise their cholesterol and levels of lipids and lipoproteins in the blood, a new study shows.

The rigorously high-fat, low-carbohydrate diet is known as the ketogenic diet. Researchers from Johns Hopkins Children's Center tracked 141 children, ages 4 months to 20 years old, who were diagnosed with difficult-to-treat seizures. After following the diet for six months, only one in six children in the study group had either a cholesterol or triglyceride level considered acceptable for children. The children's average total cholesterol rose to 232 milligrams per deciliter, which is well above the 200 level the medical community considers too high for children.

Despite the elevated levels, researchers believe the diet should remain a treatment because children stay on the ketogenic diet temporarily, usually only one or two years. Investigators suggest parents have their child's cholesterol and lipid profiles tested before they start the ketogenic diet.

The ketogenic diet is designed to maintain a child's normal growth and development. It is not used for weight reduction. The diet mimics some of the effects of starvation, in which the body first uses up glucose and glycogen before burning stored body fat. In the absence of glucose, the body produces ketones, a chemical byproduct of fat that can inhibit seizures. Children who remain seizure-free for two years on the ketogenic diet can resume normal eating and, generally, their seizures don't return.

SOURCE: Journal of the American Medical Association, 2003;290:912-920

Hormone Therapy Fails to Reverse Bone Loss in Dancers With Amenorrhea (August 18, 2003) 

NEW YORK (Reuters Health)

Hormone therapy does not reverse bone loss in amenorrheic ballet dancers, according to a report in the August issue of Fertility and Sterility.

In a placebo-controlled, randomized trial, Dr. Michelle P. Warren and colleagues from Columbia University, New York, examined the role of estrogen deprivation and replacement in ballet dancers with and without amenorrhea who were on hormone therapy and calcium. Fifty-five dancers with a mean age of 22 years and a mean age at menarche of 14.7 years were included in the study. Of the 55 subjects, 24 were amenorrheic.

Patients with amenorrhea were randomly assigned to receive placebo or 0.625 mg Premarin for 25 days monthly and 10 mg Provera for 10 of the 25 days for 2 years. The team compared these women with normally menstruating controls. Participants also received 1250 mg calcium daily. Main outcome measures included bone mineral density at the foot, wrist, and lumbar spine.

Of the 55 participants, twenty-six completed the study. No differences in BMD were observed between the treated or placebo groups. Compared to controls, hormone therapy did not change or normalize BMD in amenorrheic patients.

Five patients, all of whom received placebo, resumed menses during the study. These patients "did not show a normalization of BMD, despite significant increases in BMD (spine BMD 11.8%)," Dr. Warren and colleagues write.

"Exercise-induced amenorrhea may be due to a metabolic imbalance caused by a caloric intake that is insufficient for the level of activity, and the osteopenia may be another adaptive response to chronic low energy intake reflected in a low turnover state," the authors write. "Metabolic factors may be mediating the osteopenia in response to poor nutrition and energy deficit, as opposed to low sex steroid concentrations."

Fertil Steril 2003;80:398-404.

Natural Hormone may Help Heart Condition (August 18, 2003) 

(Ivanhoe Newswire)

Doctors may one day be able to treat a common heart condition that stems from obesity. Researchers from Johns Hopkins Medical Institutions report altering the chemical pathway of the hormone leptin has a positive effect on the heart. So far, research has only been conducted in animals.

Leptin is a hormone that helps regulate body weight and metabolism. In this study, researchers compared the hearts of three groups of mice. One group lacked the gene for leptin, another did not have the receptor, and the third group had no alterations. Obesity developed in the first two groups. The mice also developed left ventricular hypertrophy, a condition in which the heart expands and over time becomes stiff and stops contracting.

Next, the researchers reduced the weight of the mice in the first two groups. One group had calorie restrictions and the other was given leptin. They report the group receiving leptin had a complete reversal of LVH and also an improvement in their heart cells. They write, “We conclude that either leptin itself or a component of its downstream signaling pathway has a direct antihypertrophic (reduction in size) effect on the heart.”

This study is significant for those who have obesity-related heart disease. According to study investigators, treatment of LVH with leptin may one day be a successful approach for this deadly condition.

SOURCE: Circulation, 2003;108:754-759

Painkillers Increase Risk of Miscarriage (August 18, 2003) 

(Ivanhoe Newswire)

California researchers report taking painkillers during pregnancy increases the risk of miscarriage. Non-steroidal anti-inflammatory drugs, which include aspirin and ibuprofen, are some of the most widely used drugs and are often used by pregnant women.

Doctors interviewed 1,055 pregnant women immediately after confirmation of their pregnancy. The participants were asked questions about their drug use since they became pregnant, reproductive history, and potential risk factors for miscarriage.

The use of NSAIDs during pregnancy increased the risk of miscarriage by 80 percent. The risk for miscarriage was especially high if the NSAIDs were taken around the time of conception or were used regularly for longer than a week.

NSAIDs work by suppressing production of prostaglandins, which are fatty acids needed for successful implantation of an embryo in the womb. Researchers note these findings need further confirmation, but advise, “It may be prudent for physicians and women who are planning to be pregnant to be aware of this potential risk and avoid using NSAIDs around conception.”

SOURCE: British Medical Journal, 2003;327:368-371

Pre-Cancerous Education for Women (August 18, 2003) 

BOSTON (Ivanhoe Newswire)

In 1998, less than 5,000 cases of a condition known as DCIS were diagnosed. This year, 50,000 will be diagnosed -- not because it’s an epidemic, but because better technology can detect it.

As a mother and a self-proclaimed work-a-holic, Lois Olinger didn’t have time for interruptions in her life -- even for a mammogram. “Work got in the way," she says, "And I sort of didn’t have one for several years. That wasn’t a good thing.” Neither were the results when she finally did have one.

“They said, ‘It’s DCIS,’ and I said, ‘What is that?’” Olinger tells Ivanhoe.

DCIS, or ductal carcinoma in situ, are cancerous cells confined to the milk ducts. Despite its nearly complete cure rate, most women react like Olinger. She says, “My first question was, ‘Is this something you die from?’ The doctor assured me, ‘no’, but you really don’t believe him.”

That’s why medical oncologist Eric Winer, M.D., wants to get the word out.

“I think by educating people, one thing we can do is take away the fear that, as a result of getting DCIS, their life is going to be threatened,” Dr. Winer, of Dana-Farber Cancer Center in Boston, tells Ivanhoe.

DCIS often shows up on a mammogram as a calcification, not unlike invasive cancer. A biopsy can confirm which it is.

Dr. Winer says, “It generally is removed and most of the time it is both removed, and a woman would then receive radiation to the breast.” The only risk with DCIS is that if it’s not detected and treated, it could evolve and become invasive cancer.

Olinger realizes how lucky she was for her early detection. She says, “Now, whenever I talk to women, I say, ‘Have you had your mammogram yet? Make sure you go.’” And this reformed work-a-holic now makes time to appreciate her life.

More than 90 percent of cases of DCIS are found by mammography. Most of the time, it cannot be detected by a physician exam, and it usually does not have any symptoms. That’s one of the reasons it’s so important for women to have regular mammograms. The American Cancer Society recommends women begin getting yearly mammograms at age 40.

If you would like more information, please contact:

American Cancer Society
(800) ACS-2345
http://www.cancer.org

Mom’s Depression -- Baby’s Problem (August 18, 2003) 

LOS ANGELES (Ivanhoe Newswire)

Many nursing mothers are understandably cautious about the drugs they take, but new research suggests they don’t need to refrain from taking certain anti-depressants. In fact, one researcher at UCLA says it may be much better for the baby than the alternative.

Amy Vansickel is such a happy mom, it’s hard to believe she was clinically depressed after son Zuma and daughter Venice were born. “I would walk around for hours, wringing my hands, my head down and just sobbing for hours," she tells Ivanhoe. "And, I used to go in my garden and ask God to take me because it was so unbearable.”

She turned to postpartum depression specialist and psychiatrist Victoria Hendrick, M.D., for help. Dr. Hendrick’s research shows nursing infants of untreated depressed mothers seem to weigh less at six months.

“Infants of mothers who were depressed for a prolonged period of time, two months or more, weighed a lot less than infants of the mothers who were not depressed,” Dr. Hendrick, of UCLA Neuropsychiatric Institute in Los Angeles, tells Ivanhoe.

Amy took anti-depressants for her depression after both children were born. She breastfed her kids, and the drugs appeared to have no effect on their growth. Dr. Hendrick says untreated depression in mom might leave a child undernourished. “Depression has been linked with a reduced tendency to breastfeed, with women not breastfeeding as avidly as if they’re not depressed.”

UConn Health Center pediatrician Aruna Ramanan, M.D., agrees anti-depressants for breastfeeding moms are OK. She says: “It is quite safe for the mom to take these medicines, and yet breastfeed. We, however, do need to warn the mother that these drugs have a long half-life, so they stay in her body for a long time.”

Dr. Hendrick urges new moms to seek treatment for depression. Amy agrees. It’s not something that you can just mentally think away, or pray away, or wish away,” she says.

To be safe, doctors say babies should be monitored for side effects. Dr. Hendrick adds that depression may even cause a chemical change in breast milk, which alters its nutritional value. Postpartum depression affects 12 percent to 15 percent of women.

If you would like more information, please contact:

Joni Zuckerbrow-Miller
Recruitment Manager
UCLA’s Mood Research Program
(310) 794-9913

Born to be Overweight? (August 15, 2003) 

(Ivanhoe Newswire)

Pregnant women may be able to prevent obesity in their unborn child by providing proper nutrition, according to a new study.

Researchers in New Zealand tested rats to determine if obesity is linked to maternal undernourishment. The rats were mated and divided into two groups. The first group was undernourished throughout the entire gestational period, and the second group was put on a normal diet that contained adequate nutrition during this period. After birth, the pups from both the undernourished and nourished mothers were weaned and again separated. Half of the offspring were fed a standard diet, and the other half were fed a low-calorie diet.

Results of the study show offspring that were undernourished in the womb were significantly more sedentary in postnatal life than those born to mothers who were on a standard diet. The offspring of undernourished rats also tended to overeat when they matured. Postnatal diet had little effect on these findings, although sedentary behavior was exacerbated in those who were given a low-calorie diet after birth. Males were less active than females, but the prenatal effect was significant in both genders.

Researchers say their findings may confirm that sedentary effects are persistent throughout life and are solely related to prenatal maternal diet. They say the prenatal environment can lead to the development of both abnormal eating and exercise behaviors.

Their findings could prove that predispositions to obesity, altered eating behavior, and sedentary activity are all linked and occur regardless of habits adopted after birth. Previous studies have shown nutrition in the womb can influence physiological features of the metabolic syndrome.

SOURCE: American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 2003;285:177-182

Bad News About Diabetes or Not? (August 15, 2003) 

(Ivanhoe Newswire)

New research finds while the proportion of people with diabetes is on the rise, the number of new cases is stable, and the number of deaths from diabetes-related complications is on its way down. Researchers from Denmark report the prevalence of diabetes increased by 3 percent annually from 1993 to 1999. At the same time, there was a 3 percent reduction in the number of related deaths.

The World Health Organization estimates the number of diabetics in the world will double in the next 20 years. The researchers from this study attempted to provide an epidemiological overview of the current situation. Their study evaluated drug-treated diabetes from 1993 to 1999. The authors determined, “We note that the overall rise in incidence is due to an increasing incidence of use of oral antidiabetic medications.”

An accompanying editorial written by Edwin A. M. Gale questions the conclusions drawn by this study. Gale challenges the idea that the increase in prevalence was driven by improved longevity rather than by a rise in the number of new cases. Instead, he says prevalence estimates vary according to many factors. It can depend on the diagnostic facilities, the age of the population studied, and even the diagnostic cutoffs used at the facilities. He also faults the authors for not differentiating their study between type 1 and type 2 diabetes.

The study investigators say previous conclusions linking Western lifestyle and the growing number of diabetics may be incorrect and further research is needed to understand the causes of rising diabetes prevalence.

SOURCE: The Lancet, 2003;362:537-538

Screening Program Effective for Breast Cancer (August 14, 2003) 

(Ivanhoe Newswire)

Breast cancer screening programs for low-income women appear to be effective tools for detecting cancers. A new study looked at the Oregon Breast and Cervical Cancer Program to determine the surgical outcomes of the patients. Researchers looked at the incidence of breast cancer, the stage of the cancers detected, the role of a breast exam in diagnosis and patient compliance.

Researchers from Oregon Health & Science University led the study. They tracked 15,730 women who had 23,149 mammograms and 20,396 clinical breast exams. Only 2 percent of the mammograms were suspicious, resulting in a rate of 12.3 cancers per 1,000 women. The researchers say that is higher than other screening program rates.

They write, “In contrast to some other screening programs, the low-income screening programs we report on detected a higher rate of more advanced cancers, suggesting that such services are used for the evaluation and treatment of nonoccult lesions, as well as screening.” They say the majority of evidence shows mammography reduces breast cancer death in women between ages 40 and 74. Therefore, screening programs like this one are essential.

Although clinical breast exams often lead to a false-positive rate, in this study they were responsible for detecting 10 percent of the cancers. The researchers plan to continue the study and focus on statewide clinical breast exam training programs, as well as comparing the clinical outcomes of women in this screening program with those in other programs.

SOURCE: Archives of Surgery, 2003;138:884-890

Healing a Tendon Injury (August 13, 2003) 

PHILADELPHIA (Ivanhoe Newswire)

In the past, a tendon injury has meant cortisone shots to ease the pain or surgery in severe cases. Now, doctors in Philadelphia have found a way to repair injured tendons through a simple procedure. Here's how it works and why injuring it again, is good.

A little pain is not enough to keep BJ Hoffman from working out. “I didn’t stop because I had a goal," she tells Ivanhoe. "I needed to do this contest, so I kept working through it.” But that drive landed her in more severe pain. “As soon as I even went to turn a shower knob or pick up a glass to drink, it was like someone taking a knife and stabbing me.”

Hoffman had an injured tendon in her elbow. Typically patients have surgery or live with the pain. She was offered another option.

“We’re trying to get enough of the tendon to repair itself, such that the tendon will be functional and be either asymptomatic or only very minor symptoms,” says Levon Nazarian, M.D., a radiologist at Thomas Jefferson University Hospital.

Dr. Nezarian repairs the injury using a needle and ultrasound. “Ultrasound then gives you the ability to watch in real time as the needle comes in, gives the anesthetic, and then performs the procedure,” he tells Ivanhoe.

You can see as the needle is pulled back and forth to rough up the edges of the tear. New blood vessels produce collagen cells that heal the tear.

Dr. Nazarian says, “To take this subpopulation of people who have not responded to anything and make about two-thirds of them better, to us, is a very significant result.”

Patients are typically back to normal activity within 12 weeks. As for Hoffman, “I stopped after I had the thing done for about five days before I started to pick up a very light weight.”

In just three months, she was back adding more trophies to her collection.

Dr. Nezarian says using ultrasound for musculoskeletal injuries is relatively new, and this procedure requires both the radiologist and a sports medicine physician. The procedure is only recommended for tendons that are partially torn. He says it can also be used for partial muscle tears.

If you would like more information, please contact:

Levon N. Nazarian, M.D.
Thomas Jefferson
University Hospital
7th Floor, Main Building
132 South 10th Street
Philadelphia, PA 19107-5244
(215) 955-4916
levon.nazarian@jefferson.edu

Laser out Varicose Veins (August 13, 2003) 

(Ivanhoe Newswire)

A recent study shows non-surgical laser treatment of varicose veins is more effective than traditional surgery. By definition, varicose veins are “prominent veins that have lost their valve effectiveness and, as a result of dilation under pressure, become elongated.”

Varicose veins are more than just a cosmetic problem; they can cause aching leg pain, night cramps, fatigue, and leg heaviness. They affect one in two people age 50 or older and about 15 percent of men and 25 percent of women overall.

Using duplex ultrasound imaging guidance, doctors at the Weill Cornell Medical Center inserted a thin catheter, about the width of spaghetti, into the vein of the 423 participants. Then they applied laser energy to the vein, to heat and seal it closed. The procedure produced no scarring and did not require surgical incision.

Results of the study show a 98-percent success rate. Lead investigator Robert J. Min, M.D., reports, “Even when you remove the vein with surgery, there is a 10-percent to 25-percent chance of recurrence. We have less than 7-percent recurrence rate for a much less invasive procedure.”

The laser treatment is an outpatient procedure that is performed with local anesthetic and takes less than an hour. The recovery time is rapid compared to the standard two-weeks time with traditional surgery. Dr. Min says, “Patients were able to return to normal daily activity immediately.” Also, the cost of this treatment is about $2,000 to $3,000 per leg; traditional surgery typically costs three times that amount.

SOURCE: Journal of Vascular and Interventional Radiology, 2003;14:991-996

Common Plant Triggers Asthma (August 11, 2003) 

(Ivanhoe Newswire)

Different types of airborne pollens can trigger asthma problems. A new study finds two common European plant pollens trigger more emergency hospital admissions than average.

The research was conducted from 1995 to 1998 in Madrid. During this time, researchers tracked all hospital admissions for respiratory illnesses. They also collected data on pollen levels from trees and plants from 10 monitoring stations and information on air pollutants, temperature and humidity levels. They compared this data with the hospital admissions.

The study reports there were close to 5,000 emergency admissions and half involved children. They found, at times, the emergency admissions rose but did not reach epidemic levels. They also found heavy rains tended to lessen the amount of circulating pollen.

Researchers note in the last two weeks of May 1996 and the first two weeks of June 1998, there were dramatic surges in emergency admissions. They found these two times coincided with the release of high levels of pollen from the two plants, Plantago and Poeceae. Both of these plants are found throughout Europe.

The study found for the Poeceae plant, the emergency admission happened about three days after the high levels were recorded and two days later than high levels of the Plantago plant were recorded. Study authors say this type of time lag is consistent with the biology of allergens. They also say this surge of respiratory problems was not associated with the amount of air pollutants.

Study authors conclude there is a marked relationship with two popular plant pollens and their implication in the high levels of asthma emergencies during their release into the environment.

SOURCE: Thorax, 2003;58:703-710

Exercise could help quit smoking (August 11, 2003) 

(One News)

New research has revealed that exercise can help women quit smoking. The Auckland University study shows women who exercised for several weeks before and after they stopped smoking had greater success in the longer term. The study followed 140 Auckland women for three months. Half of them took part in an exercise regime for six weeks, while the other half joined a health education programme before they all tried to quit.

Dr Harry Prapavessis from the university's Sport and Exercise Science Department, says the women who exercised showed more success in giving up the habit in the longer term and also increased their fitness.

Prapavessis says the group that did not exercise increased their smoking again after they stopped. He says it is important to establish an exercise routine before trying to quit. An update on how the women fared after a year will be released in several months.

Wait Between Pregnancies (August 11, 2003) 

(Ivanhoe Newswire)

New research shows women who allow only short intervals of time between pregnancies are at an increased risk for developing complications.

Researchers in Scotland studied nearly 90,000 women who had given birth twice between 1992 and 1998. Results of the study show women with complicated first births are much more likely to become pregnant again in less than six months. They are also more likely to be younger than 20 years old, smoke, and live in a socially and economically deprived area.

Women who did not wait long before becoming pregnant with a subsequent child were at an increased risk for complications such as premature birth, neonatal death, and low birth weight. Even women who did not have complicated first pregnancies were at an increased risk for premature birth and neonatal death.

Authors of the study say women should be informed about the potential risk of complications. They say contraceptive advice should be give to those who are most likely to conceive shortly after giving birth -- teenagers and women who have lost a newborn baby.

SOURCE: British Medical Journal, 2003;327:313-316

HRT: A Difficult Decision (August 8, 2003) 

(Ivanhoe Newswire)

Women taking hormone replacement therapy may want to talk to their doctors about whether to stay on the drugs. A new study involving over a million women provides strong evidence that the use of HRT is associated with a greater risk of breast cancer. The study found combination HRT puts women at a great risk. The study also reports an increase risk of death from breast cancer in women who used HRT compared to those who have not.

Between 20 percent and 50 percent of all women between 45 and 70 years old are taking HRT. The current research was set up to look at HRT, breast cancer and fatal breast cancer. One million women between 50 and 64 years old from the UK were recruited for the study between 1996 and 2001. Half of the women had used HRT, more than 9,000 of them were diagnosed with breast cancer, and 637 deaths from breast cancer were reported.

The study found women on all types of HRT including estrogen-only, combined estrogen-progestagen, and tibolone were at an increased risk of breast cancer compared with those who never took HRT. The use of combined HRT was associated with a substantially greater increase in risk than other types of HRT. In fact, study authors say combined HRT causes four times as many extra breast cancer cases as oestrogen-only HRT.

In an accompanying commentary, Chris van Wheel, from the University of Nijmegen in the Netherlands, says women need to talk to their doctors about the current research findings. He says no one will benefit from panic or overreaction, but he urges doctors to discuss treatment options and risks of HRT with their patients.

SOURCE: The Lancet, 2003;362:419-427,414-415

Penicillin Protects Against Stroke (August 8, 2003) 

(Ivanhoe Newswire)

A common antibiotic may help protect some people from having a stroke, according to new research. The study finds elderly patients with hypertension who were taking penicillin were half as likely to suffer a stroke as compared to patients not on the antibiotic.

Many previous studies have found a link between infections and heart disease or stroke. The thought is that treating the infection with an antibiotic could prevent or slow the progression of cardiovascular disease. However, the studies have had inconsistent results. Researchers from McGill University Health Center’s Department of Medicine conducted a study to see if antibiotic use is associated with the risk for a stroke in elderly patients with high blood pressure.

For the study, researchers looked at the health records of close to 30,000 patients treated for hypertension. They focused on 1,888 patients who had suffered a stroke. They then selected 9,440 patients who did not have a stroke to serve as a comparison. Investigators had information on antibiotic use for up to 14 years on each patient. Researchers noted what antibiotic was used, when and how long. They then compared the data from the two groups.

The study found current, recent and past use of penicillin all showed a protective benefit against having a stroke. Specifically, current penicillin users were 47-percent less likely to have a stroke. Those who had taken the antibiotic recently had a 27-percent reduction in stroke risk. Researchers also report the other antibiotics noted in the study did not show the same consistent benefit against stroke.

Researchers caution their study was an observational study, and there are some limits to their results. However, they say the association between penicillin use and stroke is intriguing and should be explored further.

SOURCE: To be published in an upcoming issue of Stroke

New Treatment for Diabetic Foot Ulcers (August 8, 2003) 

(Ivanhoe Newswire)

Researchers at Washington University School of Medicine in St. Louis say surgically lengthening the Achilles tendon of patients with diabetes can reduce the risk of foot ulcer recurrence.

Of the 17 million diabetic Americans, about 15 percent will develop foot ulcers. Nerve damage occurs as the disease progresses, making it hard for diabetics to perceive a developing foot injury until the wound becomes infected. Traditional treatment for foot ulcers in diabetics includes immobilization of the infected foot with a cast, which forces the patient to keep pressure off of the wound. Even after treatment, some patients may still develop more ulcers.

Each of the 64 participants in this study had an ulcer on the ball of the foot. One group received the traditional treatment, while the other received the Achilles tendon lengthening surgery and the standard cast. During surgery, Jeffery E. Johnson, M.D., of Washington University, explains, the foot was anesthetized and three nicks were made into the tendon. Dr. Johnson says, “The patient’s foot was adjusted to stretch the tendon and then was immobilized for six weeks.”

Seven months after initial treatment, researchers report the group receiving the Achilles lengthening was “75 percent less likely to have an ulcer recurrence than the group who received only a cast.” Michael J. Mueller, Ph.D., associate professor of physical therapy, concludes, “This study shows that lengthening the Achilles tendon can have a dramatic effect on the problem of ulcer recurrence.” Lengthening the tendon can cause weakness in the calf muscles and thus, unsteadiness, but strengthening exercises can reduce these side effects.

SOURCE: Journal of Bone and Joint Surgery, August 2003

Butter blamed as diet villain (August 7, 2003) 

(One News)

New Zealanders' high butter consumption has been identified as a villain in the nation's health-threatening diet.

The Ministry of Health and Auckland University report suggests two out of every five deaths are due in part to an unhealthy diet and not enough exercise.
It said New Zealand's consumption of the saturated fat is more than twice Australia's and we should be aiming to bring our consumption down to about the same level.
One of the authors, Dr Anthony Rodgers of Auckland University, says butter is the biggest single source of saturated fat consumed in New Zealand.

Although butter consumption in New Zealand is still high compared with other western countries, it is declining.

Peter McClure, chief executive of NZ's biggest marketer of dairy products, Dairy Foods, says retail butter sales are falling by 5% to 6% a year, mostly due to changing livestyles.

A professor of nutrition and medicine from Otago University says any initiatives aimed at reducing poor diet and exercise habits should be piloted and evaluated before being adopted.

Professor Jim Mann says there are many ways to encourage healthier living such as providing areas for people to exercise.

Meanwhile, vegetable growers are hoping people will eat more of their product following new research.
A $22 million transtasman project called Vital Vegetables will investigate the health benefits of vegetables.

New Zealand and Australian vegetable growers are collaborating with Crop and Food Research and Australia's Primary Industries Department on research designed to produce healthier, tastier vegetables.

Chief executive of New Zealand vegetable growers' federation, Peter Silcock, says consumer demand and competition from other food products is driving the project.

Better Breast Cancer Screening (August 7, 2003)