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January 2007 News Archives
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January 2: To Protect Against Drug Errors, Ask Questions, The New York Times
By JANE E. BRODY
The elderly aunt of a colleague was sharp as a tack, living on her own and busy doing everything a healthy woman in her 80s might want to do. That is, until she went to the pharmacy to pick up a refill of methazolamide, the pills she took to control her glaucoma, and instead was given methotrexate, a potent chemotherapy drug that suppresses immunity. The woman noticed that the color of the new pills was different from her previous pills and questioned the pharmacist, who told her they were fine. She even counted them, noting that she was short six pills. But on the pharmacist’s reassurance, she took them for a month, by which time the drug had seriously suppressed her body’s immune system.
The woman developed a painful attack of shingles that she couldn’t shake off. She lapsed into a coma, and when she finally emerged, she was no longer able to care for herself.
A similar error befell my father at a leading New York hospital. After weeks of intensive care following a massive heart attack, he was sent home with medication from the hospital pharmacy to prevent his body from rejecting his damaged heart. He was about to take the first pill when my mother noticed that the name on the vial was Mrs. Rosenberg, not Sidney Brody, and that it contained estrogen, not the prednisone my father needed.
Medication errors are among the most common medical mistakes, injuring or killing at least 1.5 million people a year and incurring at least $3.5 billion a year in extra hospital costs alone, according to a report issued in July by the Institute of Medicine of the National Academy of Sciences. This was the institute’s second report on the subject, and the committee that compiled it stated that insufficient progress had been made since its first report, "To Err Is Human," was issued in 1999.
"We need a comprehensive approach to reducing these errors that involves not just health care organizations and federal agencies, but the industry and consumers as well," said Linda R. Cronenwett, dean of the School of Nursing at the University of North Carolina in Chapel Hill and co–chairwoman of the institute committee.
While consumers can do little to improve drug–prescribing procedures in organizations, they can do a lot more to protect themselves.
Know What You Are Taking
Preventing medication mishaps starts with knowing what medications you are taking – or supposed to be taking – and how they might interact with other drugs, supplements or herbal remedies you take and even the foods you eat.
Far too many patients leave the doctor’s office or medical clinic with a prescription that borders on the illegible. They may have been told the category of the drug – antibiotic, for example, or painkiller – but not its name. And they may have at best a vague memory of how to take it – how much, when and with what. Rarely are they warned of possible adverse effects and what to do if they notice no improvement or a downturn in their health.
You can help protect yourself by maintaining a list of all the drugs you take – prescription and nonprescription, vitamin–mineral supplements and herbal remedies, including the dosing schedule and amount. Bring this list with you whenever you visit the doctor and make sure it is reviewed by the health care provider.
If you have ever experienced an allergic reaction to a medication, or have a food allergy, be sure to tell your health care provider before any medication is prescribed.
When you are given a prescription, ask the name of the drug, what it is supposed to do for your condition, how much to take and how often it should be taken, whether it should be taken with food or on an empty stomach, what side effects are possible and what effects warrant a prompt call to the doctor. Also ask how the medication might interact with other remedies you take or foods you eat. And, of course, write down the answers while you are still in the doctor’s office.
When picking up the prescription, check the name and dosing schedule against what the doctor told you. If the labels are too small to read, bring a magnifying glass or ask the pharmacist or someone with better vision to read it to you.
If you have any questions, ask. It is the pharmacist’s responsibility to explain how to take the drug properly, its side effects and what to do if you experience them. The pharmacist can also provide written information about the drug.
Many consumers sign a book when they pick up a prescription, not realizing that their signature means they have received needed information about the drug or that they are waiving their right to such information.
When patients are too ill to obtain adequate information about their medications, a surrogate – family member, friend, or, in a hospital, a nurse, social worker or patient advocate – should obtain it for them.
The Institute of Medicine committee noted that hospitalized patients have a right to have a surrogate with them whenever they receive medication and are unable to monitor the process themselves. Many mistakes are made when hospital personnel administer the wrong drug or the wrong dose, give the drug by the wrong means (intravenously instead of intramuscularly, for instance) or to the wrong patient.
The administering nurse should always check the patient’s hospital bracelet against the name on the medication before giving it and should tell the patient the purpose for a drug each time it is administered.
If you are scheduled for surgery or an invasive exam like a colonoscopy, make sure you ask what drugs you can or should take preoperatively and which you should stop taking. Aspirin and its over–the–counter relatives, as well as prescribed blood thinners, can result in uncontrolled bleeding during such procedures.
Before leaving the hospital, ask for a list of the medications you should be taking at home. Have the provider go over the list with you and be sure you understand how much of each to take and how to take it. Again, write it down or have your surrogate write it for you.
Follow Directions
Failure to take medications according to the prescribed directions is one of the most common reasons for bad outcomes. Sometimes this results from a misunderstanding of dosage schedules. The label may say "Take one capsule every six hours" but the patient assumes, incorrectly, that this does not include the hours during sleep. Or the patient, whose native language is Spanish, may read "once" as 11 o’clock, as it could be interpreted in Spanish, instead of as one time.
It is vitally important to follow warnings about possible drug or food interactions or hazards operating motorized equipment, including cars, while taking the medication.
Most pharmacies now routinely place yellow warning stickers on medicine vials, and many include patient information leaflets with the drugs they dispense. It is the consumer’s job to read these and follow directions like "take with food" or "do not drink alcohol while on this drug."
Many consumers now check out prescription and alternative remedies on the Internet. This can be risky because most of this information is posted by lay or commercial sources, not medical experts. If you use the Web, make sure the information is provided by an official government source, such as the National Library of Medicine’s MedlinePlus program (www.medlineplus.gov), which provides easy–to–read drug information and interactive tutorials.
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January 2: Medical Teams Are Key To Patient Safety, Medical News Today
Medical teams – not individuals – are critical to the prevention of catheter–related bloodstream infections, as well as for the overall health, safety, and welfare of patients, according to an editorial by two Virginia Commonwealth University physicians published in today’s issue of the New England Journal of Medicine.
Intensive care unit professionals use a number of devices and catheters to deliver intravenous fluids and medications to patients. There is risk of bloodstream infection anytime a worker handles a catheter, and the key organisms linked to these infections are commonly found on the patients’ skin, or sometimes on healthcare workers’ hands.
In the United States, an estimated 50,000 bloodstream infections occur in ICUs each year related to central catheters, with approximately half these cases resulting in patient death.
"When it comes to patient safety, we need teams of healthcare workers to foster excellent care," said Richard P. Wenzel, M.D., professor and chair in the Department of Internal Medicine in the VCU School of Medicine and president of the International Society for Infectious Diseases, the largest professional organization related to infectious disease. "Today any breech in technique is not acceptable, and we now have zero tolerance. The team itself creates a social pressure of excellence for patient safety."
In an editorial commenting on a recent study published in the New England Journal of Medicine, Wenzel, together with Michael B. Edmond, M.D., acting chair in the Division of Infectious Diseases, emphasized the value of medical teams in the prevention of catheter–related bloodstream infections. The study, by a research team from the Johns Hopkins University School of Medicine, showed that teams of physicians and nurses in Michigan hospitals reduced the rates of infection by almost 70 percent.
"The work of Dr. P. Pronovost and colleagues is the most important paper published in infection control in the last decade because it demonstrates that careful attention to good practices results in a dramatic reduction in bloodstream infections," said Edmond.
Wenzel said that in the past, colleagues in ICUs would avert their eyes from healthcare workers who failed to wash their hands, or had a small tear in their glove, and would continue with the procedure rather than restarting it.
"There have been significant improvements to patient safety, and patients are safer in hospitals today, compared to 10 years ago," Wenzel said. "It is reasonable for patients to take charge of their care to some extent. I tell my patients not to allow anyone to touch them or any catheter unless they first see them wash their hands and put gloves on," he said.
Wenzel said that to prevent infection, it is imperative for the healthcare team to engage in the basic techniques of hand–washing, to follow strict protocols and to use the catheters for only as long as necessary.
About VCU and the VCU Medical Center: Virginia Commonwealth University is the largest university in Virginia and ranks among the top 100 universities in the country in sponsored research. Located on two downtown campuses in Richmond, VCU enrolls more than 30,000 students in nearly 200 certificate and degree programs in the arts, sciences and humanities. Sixty–three of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 15 schools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the nation’s leading academic medical centers. For more, see http://www.vcu.edu.
Virginia Commonwealth University
816 W. Franklin St., PO Box 842036
Richmond, VA 23284
United States
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January 3: Folic Acid May Slow Age–Related Hearing Loss, The Washington Post
By Steven Reinberg
HealthDay Reporter
WEDNESDAY, Jan. 3 (HealthDay News) –– Age–related hearing loss, a common problem among the elderly, might be related to inadequate levels of folic acid, European researchers report.
The researchers found that people who took a folic acid supplement had less decline in hearing low–frequency sounds over time, compared with people who didn’t take the supplement.
Results of the study, led by Jane Durga, of the Cognitive Sciences Group, Nutrition & Health Department at the Nestle Research Center in Lausanne, Switzerland, are published in the Jan. 2 issue of the Annals of Internal Medicine.
The researchers randomly assigned 728 older Dutch men and women, who showed signs of age–related hearing loss and low folate levels, to receive either 800 grams of a folic acid supplement or a placebo daily for three years.
Durga’s team chose to conduct the study in the Netherlands because, unlike the United States, the Netherlands does not fortify its food with folic acid, a B vitamin also known as folate. Folate levels in study participants were about half those found in Americans. In the United States, many foods contain supplemental folic acid because of its benefits in protecting against birth defects.
At the end of the trial, the researchers found that the ability to hear low–frequency sound did not decrease significantly among those taking folic acid supplements. However, there was no slowing in the decline in hearing high frequencies in either group.
The thresholds of the low frequencies increased by 1.0 decibel in the folic acid group and by 1.7 decibels in the placebo group, the researchers said.
"Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population from a country without folic acid fortification of food," the researchers wrote. "The effect requires confirmation, especially in populations from countries with folic acid fortification programs."
But Robert W. Sweetow, director of audiology at the University of California, San Francisco, Medical Center, called the results "clinically insignificant."
"I think that their conclusion that folic acid is actually slowing down the progression of age–related hearing loss is a stretch," Sweetow said. "I would hate to say to patients, ‘You take folic acid and the progression of your hearing loss is going to slow down.’"
Another expert questioned the significance of the finding.
"The effect is on low frequency hearing, but most older folks have a problem with high frequency hearing," said Dr. Hinrich Staecker, an associate professor in the department of otolaryngology–head & neck surgery at the University of Kansas Medical Center.
Staecker also noted that the study authors didn’t look at the ability of the participants to hear speech clearly. "It’s easier to make stuff louder, but it’s not easy to make stuff clearer," he said.
Dr. Peter M. Rabinowitz, an associate professor of medicine at the Yale University School of Medicine, said, "The investigators’ finding that low–frequency, but not high frequency, hearing loss was reduced in the folate supplementation group is somewhat surprising, since age–related hearing loss usually affects the higher frequencies of hearing first and to a greater degree."
Clearly, much is not known about nutrition and hearing, Rabinowitz said. For example, other studies have suggested that genetic differences in the metabolism of folate may affect how someone responds to supplementation, including the effect of folate on hearing loss, he said.
"While neither this study nor the current state of medical knowledge provide adequate evidence for recommending particular supplements to prevent hearing loss, this study provides additional evidence of the importance of adequate nutrition in older adults, as well as the potential for future discoveries of how to slow the aging process of the hearing system," Rabinowitz said.
More information
The U.S. Food and Drug Administration can tell you more about age–related hearing loss.
SOURCES: Hinrich Staecker, M.D., Ph.D., associate professor, department of otolaryngology–head & neck surgery, University of Kansas Medical Center, Kansas City; Peter M. Rabinowitz, M.D., M.P.H., associate professor of medicine, Yale University School of Medicine, New Haven, Conn.; Robert W. Sweetow, Ph.D., professor and director, audiology, University of California, San Francisco, Medical Center; Jan. 2, 2007, Annals of Internal Medicine
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January 8: Blood pressure drugs useful for breathing problem, Reuters
NEW YORK (Reuters Health) – Treatment with blood pressure drugs called beta–blockers appears to improve the severity of central sleep apnea in patients with chronic heart failure, according to study findings reported in the journal Chest.
Central sleep apnea involves periods when an individual stops breathing during sleep, which is caused by a failure of the brain to send appropriate signals to the breathing muscles.
The authors note that up to 50 percent of patients with the most common type of heart failure have central sleep apnea. The current findings are based on study of 45 patients with chronic heart failure, of whom 27 were taking the beta–blocker carvedilol and 18 who were not.
Treatment with carvedilol (Coreg) appeared to improve the severity of sleep apnea, report Dr. Akira Tamura and colleagues, from Oita University in Japan. Moreover, the improvement was directly related to the dose of carvedilol.
Treatment with carvedilol for 6 months led to significant improvements in sleep apnea for five patients who had severe breathing problems when the study began, the report also shows.
"These results suggest that beta–blocker therapy may...reduce the severity of central sleep apnea in patients with chronic heart failure," the researchers conclude.
SOURCE: Chest, January 2007.
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January 9: Genetic Alterations Found in Head and Neck Cancers, HeathDay News
Acquired genetic changes appear to be linked to the development of some head and neck cancers, new research suggests.
U.S. scientists said they’ve discovered five genetic alterations in tissue surrounding head and neck cancer tumors that are associated with a tumor’s aggressiveness. They also found three genetic changes that were associated with a tumor’s size and ability to spread.
"We found genetic alterations in the innocent–looking cells around head and neck cancers," said the study’s lead author, Dr. Charis Eng, chairwoman and director of the Genomic Medicine Institute at the Cleveland Clinic Foundation in Ohio. "Why and how these changes occur, we don't know."
Each year, about 31,000 Americans are diagnosed with head and neck cancer and about 7,400 die from the disease, according to background information in the study. While progress has been made in treatment, half of all people who develop this form of cancer will eventually die from it, reports the study.
About 85 percent of people who develop head and neck cancers are tobacco users, according to the National Cancer Institute (NCI). Alcohol use is also an important risk factor for this disease, and people who use both tobacco and alcohol have the greatest risk, according to the NCI.
To get a better understanding of how these cancers develop, researchers from the Cleveland Clinic and Case Western Reserve University examined cells from 122 head and neck cancer tumors and from surrounding tissue. All of the tissue samples came from people who smoked.
These samples underwent a whole genome analysis, with the researchers specifically looking for deletions in the genes, according to Eng.
The researchers discovered genetic alteration "hot spots" – – or compartments – – in the supposedly normal tissue surrounding the head and neck cancers. Five genetic alterations related to a tumor’s aggressiveness were found, and three were linked to tumor size and its ability to spread, or metastasize. Another two hot spots were identified in the cells around the tumors, and these were associated with the tumors’ ability to spread and appeared to be useful for staging of the disease.
"These are new biomarkers that can tell us which are aggressive tumors and which are not," Eng explained. And, she said, "Suddenly, instead of just targeting the tumor, we can work on developing therapies to target these new compartments."
However, she added that this work needs to be replicated by other researchers.
Eng said the researchers didn’t design the study to identify what caused the genetic alterations, but that smoking likely plays a role in the development of cancerous cells. She said she wouldn't yet "make the leap" to say the genetic changes in the tissue around the cancer were caused by smoking, because that research hasn't been done. She did, however, say that these genetic alterations were acquired and not hereditary alterations.
Of the study, Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic Health System in Baton Rouge, La., said, "With further work, these findings may help to identify specific genes that can predict aggressiveness."
He added that what’s most important to take away from this study is that, "Once again, we have clear evidence that the carcinogens in tobacco affect cells that cause cancer and probably the cells surrounding the cancer. Carcinogens from tobacco bathe the area and may cause molecular alterations in the cells surrounding cancers."
More information:
The American Academy of Otolaryngology has more information on head and neck cancer.
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January 9: Snoring Tears into Sleep, Relationships, MSNC
According to a relationship and sex therapist in Chicago, snoring is a "big relationship divider." Snoring creates frustration and resentment on both sides: the snorers, who can’t help it, and those suffering next to them. The American Academy of Otolaryngology is cited for noting that nearly half of adults snore occasionally, and a quarter are habitual snorers. Surgery can fix snoring caused by a deviated septum and there are more than 300 devices patented as snoring cures, although few are recommended by physicians. It notes that serious snorers should be evaluated by an otolaryngologist, an accredited sleep clinic, or both.
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January 9: Sleep apnea linked to family heart disease, United Press International
Patients with obstructive sleep apnea are more likely to have a family history of premature death due to coronary artery disease, says a U.S. study.
Researchers from the Mayo Clinic College of Medicine in Rochester, Minn., analyzed the relationship between obstructive sleep apnea and premature death due to coronary artery disease by comparing the personal and family histories of 316 patients with obstructive sleep apnea and 202 patients without obstructive sleep apnea.
Regardless of the patient’s own coronary artery disease status, there was a significant and independent association between obstructive sleep apnea and family history of premature coronary artery disease mortality.
The study appears in the journal Chest.
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January 17: Warm winter bad for your health?, wkyc.com
NEW YORK (AP) – – Warm winter weather is taking a toll on people’s health.
Spring really shouldn't be in the air in January.
And what’s in the air could be a pain to those with allergies to pollen.
Dr. Jordan Josephson is a sinus specialist at Lenox Hill Hospital in New York City.
He says the mild weather has produced a "pretty ruthless" season for coughs and colds.
Inconsistent weather leaves many people wearing clothes that aren’t appropriate for conditions which could lower their resistance.
And children returning to school are coming into contact with more germs, and passing them along.
Josephson says there are some ways to cope.
He says people should get plenty of rest, drink lots of liquids and eat right.
But if symptoms persist and develop into sinus infections, he says people must see their doctors for antibiotics.
Josephson has also written a book with tips for relief of sinus ailments, called "Sinus Relief Now."
© 2007
The Associated Press
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January 17: Blood Test Distinguishes Mononucleosis, Tonsillitis, HealthDay News
A common blood test that measures a patient’s ratio of white blood cell types can help doctors distinguish between tonsillitis and mononucleosis and provide appropriate treatment, British researchers say.
Tonsillitis and mononucleosis are common conditions with similar symptoms, including sore throat, fever, painful swallowing, redness of the throat and tonsils, and white plaque on the tonsils, according to background information in the study.
"The importance of differentiating patients with tonsillitis from those with glandular fever (mononucleosis) is the prevention of spontaneous rupture of the spleen and acute intra–abdominal hemorrhage," both of which are potential complications of mononucleosis, the researchers wrote.
Currently, an expensive mononucleosis spot test is required to differentiate between the two conditions.
In this study, the researchers analyzed laboratory test results from 100 patients with bacterial tonsillitis and 120 patients with infectious mononucleosis. They looked at the number of lymphocytes (a type of white blood cell involved in immune response) and overall white blood cell count, and found the lymphocyte/white blood cell count ratio averaged 0.54 in the mononucleosis patients and 0.10 in tonsillitis patients.
The study authors concluded that people with a ratio of higher than 0.35 would be correctly diagnosed with mononucleosis 90 percent of the time and people with a ratio of 0.35 or lower would be correctly diagnosed as not having mononucleosis 100 percent of the time.
"In conclusion, we recommend that the lymphocyte–white blood cell count ratio should be used as an indicator to decide whether mononucleosis spot tests are required," the study authors wrote. "Results from our retrospective pilot study suggest that the lymphocyte–white blood cell count ratio could be quickly available alternative test for the detection of glandular fever (mononucleosis)."
The study is published in the January issue of theArchives of Otolaryngology–Head & Neck Surgery.
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January 18: Stem cell marker identified in head and neck cancer, Innovations Report
U–M, Stanford researchers report first evidence of cancer stem cells in head and neck tumors.
Researchers have found a marker on head and neck tumor cells that indicates which cells are capable of fueling the cancer’s growth. The finding is the first evidence of cancer stem cells in head and neck tumors.
Cancer stem cells are the small number of cancer cells that replicate to drive tumor growth. Researchers believe current cancer treatments sometimes fail because they are not attacking the cancer stem cells. By identifying the stem cells, researchers can then develop drugs to target and kill these cells.
"Our treatment results for head and neck cancer are not as good as we’d like them to be. A lot of people still die of head and neck cancer. This finding will impact our understanding of head and neck cancer, and we hope it will lead to treatments that will be more effective," says study author Mark Prince, M.D., assistant professor of otolaryngology at the University of Michigan Medical School and section chief of otolaryngology at the VA Ann Arbor Healthcare System.
Results of the study appear in the Jan. 16 issue of the Proceedings of the National Academy of Sciences.
Researchers at the U–M Comprehensive Cancer Center and Stanford University School of Medicine took tumor samples from patients undergoing surgery for head and neck squamous cell carcinoma, including cancers of the tongue, larynx, throat and sinus. Cells from the samples were separated based on whether they expressed a marker on their surface called CD44. The sorted cells were then implanted into immune–deficient mice to grow tumors.
The cells that expressed CD44 were able to grow new tumors, while the cells that did not express CD44 did not grow new tumors. The tumors that grew were found to be identical to the original tumors and to contain cells that expressed CD44 as well as cells that did not express the marker. This ability to both self–renew and produce different types of cells is a hallmark of stem cells.
Stem cells have been identified in several other cancer types, including breast, brain, central nervous system and colon cancers, as well as leukemia. U–M researchers in 2003 were the first to report the existence of stem cells in a solid tumor, finding them in breast cancer. CD44 was also found to play a role in breast cancer stem cells.
"We know CD44 is important in breast cancer and now in head and neck cancer, so it might be important in other cancer types. This work gives more evidence that the cancer stem cell theory is valid," Prince says.
That theory suggests that a small subpopulation of cancer cells are the critical cells in cancer growth and progression, and the key to treating it is to kill the stem cells. It’s a radically different model than current treatment approaches, which are designed to shrink the tumor by killing as many cells as possible. Researchers suspect cancer recurs because the treatments are not killing the stem cells.
The current finding in head and neck tumors does not pinpoint the exact stem cells, the researchers believe, but rather narrows down the field. The percent of cells within a tumor expressing CD44 varied from one sample to the next, with one sample composed of as high as 40 percent of these cells. Studies in other cancer types have found the stem cell population to be smaller than 5 percent.
"The CD44–positive cells contain the tumorigenic cells, but we don’t think that’s a pure population of cancer stem cells. We still need to drill down further to find the subpopulation of those cells that is the pure version," Prince says.
In addition to Prince, U–M study authors were doctoral student Andrew Kaczorowski and Gregory Wolf, M.D., professor and chair of otolaryngology. Stanford authors were Ranjiv Sivanandan, Michael Kaplan, M.D.; Piero Dalerba; Irving Weissman, M.D.; Michael Clarke, M.D.; and Laurie Ailles.
Funding for the study was from the U–M Specialized Program of Research Excellence (SPORE) grant in head and neck cancer and from an anonymous gift fund for cancer stem cell research at Stanford University.
While promising, this research is still in the early stages of animal testing, and more research must be done before it could benefit patients with head and neck cancer. No therapeutic treatments or clinical trials are available at this time. For information on existing options for head and neck cancer, call Cancer AnswerLine at 800–865–1125 or visit www.cancer.med.umich.edu/cancertreat/headandneck/index.shtml.
Reference: Proceedings of the NationalAcademy of Sciences, Vol. 104, No. 3, pp. 973-978
Written by Nicole Fawcett
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January 18: Clues To Cause Of Difficulty With Swallowing In Children, ScienceDaily
Eosinophilic esophagitis (EE) is disease that was first described in children only 20 years ago, but has shown a rising incidence in both children and adults. An inflammatory condition of the esophagus, its symptoms including vomiting, heartburn and difficulty in swallowing.
In findings published on line January 10, 2007 in the Journal of Allergy & Clinical Immunology, researchers at the University of California, San Diego (UCSD) School of Medicine and Rady Children’s Hospital and Health Center, San Diego show that the disease causes many of the same kinds of tissue changes seen in pediatric asthma. Their research may lead to new drug targets for EE, which appears to be allergy–driven in some patients.
The esophagus is the soft tube–like portion of the digestive tract that leads from the back of the mouth to the stomach. In patients with EE, the disease leads to scarring and narrowing of the esophagus, so that food can't readily pass through it.
"We set out to find whether the kind of structural changes seen in other long–standing inflammatory diseases like childhood asthma also occur in EE," said Seema Aceves, M.D., Ph.D., of UCSD’s Allergy Immunology section of the Department of Pediatrics. Aceves is also a physician at Rady Children’s Hospital in San Diego and directs a treatment center for children with eosinophilic gastrointestinal disorders.
The research team studied biopsies of the esophagus from children with an initial diagnosis of EE who had not yet been treated, comparing them to biopsies of children with acid reflux disease as well as those of children with normal esophageal biopsies.
"We found fibrosis, or scarring, as well as remodeling of the esophagus in pediatric EE patients which is similar to airway remodeling found in patients with asthma," said Aceves.
Remodeling occurs in chronic inflammatory diseases such as asthma and results in alterations in structural cells and tissues not found in normal tissues. The UCSD study showed that children with EE were found to have previously unrecognized changes to their esophagus, including an increased number of blood vessels in the sub–epithelium, the region below the surface of the interior lining of the esophagus. There were also a larger number of adhesion molecules present in these blood vessels, which cause the vessel wall to become sticky. As a result, allergy cells adhere to the sticky vessels and are then able to cross the blood barrier, resulting in inflammation in the esophagus.
These studies – – performed by Aceves through an ongoing collaboration with the laboratory of David Broide, M.B. Ch.B., professor of medicine at UCSD School of Medicine and an expert in airway remodeling in asthma – – identified three molecules that contribute to these changes in the esophagus, and could provide new therapeutic targets for EE. Their data suggests that increased expression of the molecules TGF–beta 1, phospohrylated–SMAD2/3, and VCAM–1 may be involved in remodeling that leads to scarring and narrowing of the esophagus. These molecules may serve as markers to provide physicians with a basis for predicting disease severity.
Additional contributors to the paper include Robert O. Newbury, M.D., Ranjan Dohil, M.D. and John F. Bastian, M.D. Funding for the research was provided by the National Institutes of Health and the American Academy of Allergy, Asthma & Immunology Education and Research Trust.
Note: This story has been adapted from a news release issued by University of California – San Diego.
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January 19: New screen process for oral cancers, United Press International
RANCHO MIRAGE, Calif., Jan. 19 (UPI) – – Patients with early–stage oral cancer may benefit from an advanced screening process allowing for a more accurate diagnosis, according to a U.S. study.
"By combining conventional techniques with more modern techniques, we were able to better diagnose and determine the best options for patients with oral cancer," said lead author J.B. Epstein of the University of Illinois at Chicago.
"This approach to diagnosing oral cancer may lead to easier identification of serious pathology, significantly lessening the need for unnecessary biopsies without additional risk of false negatives."
Doctors in this study used chemiluminescent light, a pharmaceutical grade dye used in addition to the conventional visual and manual observations of the patient.
This study found that of the 84 patients studied, the dye improved either the brightness or sharpness of the identified lesions by 61 percent. Only biopsying lesions that retained the toluidine blue stain reduced the false–positive rate by nearly 59 percent while maintaining zero false negatives.
The findings were presented at the Multidisciplinary Head and Neck Cancer Symposium in Rancho Mirage, Calif.
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January 19: Health Tip: Why Do I Snore?, Forbes.com
(HealthDay News) – – Snoring is more than just an annoyance for people within hearing distance of where you sleep.
Snoring can also deprive you of restful sleep, and can indicate a serious medical problem called sleep apnea. This occurs when airflow to the lungs is obstructed, and it can lead heart problems and other health concerns.
If you’re a habitual snorer, talk to your doctor about potential causes. The American Academy of Otolaryngology – – Head and Neck Surgery offers this partial list:
- Nasal deformities, including deviated septum.
- Weak muscles in the tongue and throat.
- Excess tissue in the neck, which can be caused by obesity.
- A long soft palate and/or uvula.
- A stuffed-up nose.
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January 20: Combination Therapy Spares Some Head And Neck Patients From Surgery, Medical News Today
Giving patients with head and neck cancer a combination of chemotherapy and radiation therapy controls the cancer and allows many patients to avoid additional surgery to the neck, according to a study presented at the plenary session today at the Multidisciplinary Head and Neck Cancer Symposium in Rancho Mirage, Calif., co–sponsored by the American Society for Therapeutic Radiology and Oncology, the American Society of Clinical Oncology and the American Head and Neck Society.
"Our goal is to cure the cancer as effectively as we can while using as few treatments as possible," said Ramesh Rengan, M.D., Ph.D., lead author of the study and an assistant professor at University of Pennsylvania in Philadelphia. "This study is so exciting because it demonstrates that giving patients with head and neck cancer a non–invasive regimen of cisplatin–based chemotherapy and radiation therapy effectively treats many advanced head and neck cancers, meaning some patients can safely avoid an invasive surgery."
A standard of care for patients with advanced head and neck cancer is chemotherapy and radiation followed by surgery to the neck. This study, performed at Memorial Sloan–Kettering Cancer Center, instead focused on treating the patients with chemotherapy and radiation and then measuring the patients’ response to the therapy to see if they still needed the follow–up neck surgery. Eighty percent of the patients with advanced head and neck cancer who participated in this study had a complete response to chemoradiation alone with elimination of any detectable disease in the neck. Of these patients who achieved eradication of neck disease, 85 percent were able to maintain long–term remission without the need for additional invasive neck surgery.
For more information on radiation therapy for head and neck cancer, visit rtanswers.org.
The abstract, "Long–term Neck Control Rates After Complete Response to Chemoradiation in Patients with Advanced Head and Neck Cancer," will be presented at the plenary session on January 19, 2007.
American Society for Therapeutic Radiology and Oncology – oncologymeetings.org.
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January 20: Cancer study ordered into mobile phones, Times Online
Philip Webster, Helen Rumbelow and Alice Miles
• Government expert warns of ‘hint of a link’
• 200,000 join research into long–term users
A mass study of the long–term impact of mobile phones is to be undertaken amid fears that people who have used them for more than ten years are at greater risk from brain cancer.
More than 200,000 volunteers, including long–term users, are to be monitored for at least five years to plot mobile phone use against any serious diseases they develop, including cancer and Parkinson’s and Alzheimer’s diseases.
Professor Lawrie Challis, who is in the final stages of negotiation with the Department of Health and the mobile phone industry for the £3 million that he needs to fund the study, told The Times that research has shown that mobiles are very safe in the short term but that there is a "hint of something" for people using them longer.
In an interview, Professor Challis, a world expert on mobile phone radiation, and chairman of the government–funded mobile telecommunications health research programme, emphasised that the "hint" was just that. One European study has found a slight association and using a mobile for more than ten years. The few long–term users developed more acoustic neuroma brain tumours which were found close to the ear used for phoning.
But, because of the tiny numbers involved, "it could be by chance," he said. Asked whether the mobile phone could turn out to be the cigarette of the 21st century in terms of the damage it could inflict, he replied: "Absolutely."
He said that the study was necessary because all the important breakthroughs in what caused cancers had shown that the effects often took more than ten years to show. "You find absolutely nothing for ten years and then after that it starts to grow dramatically. It goes up ten times. You look at what happened after the atomic bombs at Nagasaki, Hiroshima. You find again a long delay, nothing for ten years. The same for asbestos."
He made plain that he was not put off because many existing studies had shown no dangers. "The fact that you don’t see anything in ten years is also more or less what you would expect if there is something happening," he said.
Announcing the new study, he said: "Because there is a hint and because the professional epidemiologists who I trust and who do this all the time feel there is a chance that this could be real, they can’t rule out the possibility. And because we all know that most cancers don’t show up for more than ten years, I think you have to carry on. It’s essential we carry on.
"Otherwise what are we going to do? If in ten or fifteen years’ time people start getting trouble it won’t show up until it’s a really big effect."
The move was welcomed by the Conservatives. Andrew Lansley, the Shadow Health Secretary, said: "It’s not scare–mongering to ask these questions for future generations. At the moment there is little evidence to suggest that use of mobile phones has any impact on health, but it is vital that there is continuing research to establish if long–term use is a danger."
Professor Challis is planning a separate study monitoring the impact of mobile phone use on children. He disagreed with the claim of some scientists that there was no cause to believe mobiles affected them differently from adults.
"We all know that if you’re exposed to sunlight as a kid you are much more likely to get skin cancer than if you’re exposed as an adult."
He insisted that there was nothing irresponsibly alarmist about his message. Even if a risk were found, people would not have to stop using phones, but perhaps reduce their use. "I do it because I think it’s worthwhile," he said.
A science of ifs, buts and maybes . . .
2006 Largest study yet, of 420,000 Danish users for up to 21 years, ruled out any large effect on any cancer after short or long-term use
• It suggested there could be a very slightly raised risk of acoustic neuroma, a rare, benign cancer of the inner ear, among users of more than ten years
• A raised risk on the side on which sufferers said they used their phones was balanced by a decreased risk on the other side – which led the scientists to suggest recall bias as the likely explanation. They said no firm conclusions could be drawn
2006 US study suggested lower sperm counts among heavy users. It is widely thought that this reflects another aspect of heavy users’ lifestyles, such as stress or a lack of exercise
2005 Interphone international study finds no effect on acoustic neuroma for ten years of use. It was unable, however, to rule out an effect for longer–term use, because of insufficient data
2004 Study suggests users have a higher risk of brain cancer if they live in rural areas. It has been suggested that this could reflect the higher strength of signal in areas with few base stations
2003 Swedish study suggests higher risk of acoustic neuroma among heavy users of analogue mobile phones, which have since been phased out. Scientists criticised the methodology of the research
2002 Finnish research suggests that phone emissions can cause abnormalities in blood vessel cells in the laboratory. Scientists that said it was not possible to draw conclusions for phone safety for real people
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January 28: Some cold prescriptions when you're flying, Pittsbury Post Gazette
By David Bear, Pittsburgh Post–Gazette
Flying with a cold is never pleasant, but travel doesn’t make allowances for such ailments. Here’s a collection of basic remedies to consider if you find yourself taking a clogged head and runny nose to the airport.
First, the primary tactic for traveling with a cold is to keep your nasal passages and Eustachian tubes open. Unfortunately, the dry atmosphere in airplane cabins makes it harder for these narrow passages to drain properly. Along with the changes in air pressure in the cabin during takeoff and landing, a blockage can result in excruciating head pain.
Take a decongestant medicine about half an hour before you actually get on the plane, and repeat the dose as necessary during a long flight.
Doctors often recommend using pseudoephedrine hydrochloride, a decongestant sold in a variety of brand names, such as Contac, Sudafed or Actifed.
Other decongestant products also provide an antihistamine, which reduces the swelling of nasal membranes. Although antihistamines can leave you feeling drowsy, that might be a plus on a long flight.
Nasal drops and sprays also can provide quick relief. Over–the–counter remedies such as Afrin and Neo–Synephrine 12–Hour, whose active ingredient is Oxymetazoline, are good choices. Even a simple spray of saline solution in each nostril can help.
For headaches and fever, acetaminophens such as Tylenol won’t irritate the stomach, but common aspirin also is a good option. Aleve Cold and Sinus combines pseudoephedrine with naproxen, a strong anti–inflamatory pain reducer.
If you have a dry cough, suppressants such as dextromethorphan (Dixoral or Benylin) can reduce the urge to cough. On the other hand, if you're coughing up phlegm, an expectorant containing Guaifenesin (Robitussin or Scottussin) is a better choice. It’s an either/or choice because combining both approaches is counterproductive.
If your ears clog during the flight, don’t try that old prescription of chewing gum, which will only dry your throat. A better choice is sucking on a Lifesaver or throat lozenge, especially if they contain Benzocaine oral anesthetic. Throat–soothing nostrums such as Halls, Fisherman’s Friend and Slippery Elm will work.
The usual technique for clearing your ears is to simultaneously pinch your nose, open your mouth wide, swallow and gently force air into your Eustachian tubes.
But if that doesn’t work and the pressure in your ears continues to build, here’s a simple, but surprisingly effective procedure. Ask the cabin attendant for a Styrofoam cup, a paper napkin and a little hot water. Wad up the napkin, put it in the cup, add the water, and place the cup over the clogged ear. While holding a cup over your ear may not do much for your image, the damp warmth may relieve the pain. Another option: placing a warm, moist towel over the forehead also can ease the pressure of sinusitis, as well as soothe itchy eyes.
Daubing a bit of Vaseline inside each nostril also will help to keep nasal membranes moist and help clear nasal passages. A thin film of Vicks VapoRub or Tiger Balm in your nostrils or on your chest may help breathing. A smear of ChapStick may also provide some relief.
There should be no problem carrying your medicines with you. The new TSA security regulations allow travelers to take up to three ounces of liquids or gels with them on the plane, and that should be plenty to get you through a flight.
This brings up another important point: stay hydrated. Drink plenty of fluids – – ideally water or fruit juices – – during the flight to counteract the dry atmosphere. While you can’t take liquids from home, once inside the security area, you can buy a bottle of water to carry on the plane.
Sipping on a warm beverage will soothe both the throat and sinus. A cup of coffee or tea will do, but a little chicken soup would be best. Take a bouillon cube from home and ask the flight attendant for a cup of hot water.
On the other hand, stay away from alcohol, which has a dehydrating effect.
One last bit of advice: Take a handkerchief or plenty of tissues, both for your comfort and that of your fellow passengers.
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January 29 Folic Acid Prevents Cleft Lip, Ivanhow Newswire
By Lucy Williams, Ivanhoe Health Correspondent
ORLANDO, Fla. (Ivanhoe Newswire) – – Pregnant women and those trying to start a family have yet another reason to take folic acid supplements. When taken during early pregnancy, folic acid substantially reduces the risk of cleft lip defects in newborns.
Previous research suggests folic acid supplements prevent neural tube defects, such as spina bifida. New research reveals women who take a daily dose of just 400 micrograms of folic acid during the first three months of pregnancy are less likely to have babies with cleft lip.
"It’s pretty important that women who have any chance of getting pregnant should take the recommended dosage of folic acid, which is 400 micrograms a day," senior investigator Allen Wilcox, M.D., Ph.D., of the National Institute of Environmental Health Sciences in Durham, N.C., told Ivanhoe. "That was the amount in our study that had a protective effect and provided some protection against neural tube defects."
Researchers identified 1,336 infants born between 1996 and 2000 – – 377 born with cleft lip, 196 with cleft palate only, and 763 healthy controls. The mothers completed surveys about their reproductive history. In the surveys, mothers revealed what they ate, drank and smoked during the first three months of pregnancy. They also disclosed whether they took folic acid supplements.
Women who took folic acid supplements of 400 micrograms or more per day reduced the risk of facial clefts in their babies by 40 percent. Women who did not take supplements but reported diets rich in folate – – the natural form of folic acid – – were 25–percent less likely to have babies with cleft lip.
Dr. Wilcox said women should boost their folic acid intake as soon as they decide to get pregnant.
"The tricky thing is it’s important to be taking those doses in the very earliest weeks of pregnancy before a woman may even know she’s pregnant, so women shouldn’t wait to start until they’re pregnant to start taking these supplements. They should start before they’re pregnant," he said.
Although women who take folic acid supplements appear to benefit the most, Dr. Wilcox said it’s still important to eat foods rich in folate.
"Eating a good diet with a lot of fresh fruits and vegetables is probably a very good thing for women who are planning to get pregnant," he said. "We shouldn’t count on pills to provide everything we need. Nothing replaces a well–balanced diet."
According to the National Institutes of Health, dietary sources of folic acid and folate include:
- Beans and legumes
- Citrus fruits and juices
- Wheat bran and other whole grains
- Dark, green leafy vegetables
- Poultry
- Pork
- Shellfish
- Liver
Even if you’re not pregnant, you can benefit from folic acid. A study published in the Jan. 20 issue of The Lancet reveals folic acid improves cognitive function in older adults. Folic acid may improve brain function by lowering levels of homocysteine – – an amino acid in the blood linked to increased risk of cardiovascular disease, stroke and Alzheimer’s disease.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e–mail every day of the week. To subscribe, go to: ivanhoe.com/newsalert/.
SOURCE: Ivanhoe interview with Allen Wilcox, M.D., Ph.D.; British Medical Journal Online, published online Jan. 26, 2007
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January 30: Corticosteroids help hearing–loss recovery, United Press International
SEOUL, Jan. 30 (UPI) – – Time and oral corticosteroid therapy can help patients regain full hearing, often within a month of sudden hearing loss, say researchers in Seoul.
A first–of–its–kind study into time–dependent treatments of sudden sensorineural hearing loss is published in the February issue of Otolaryngology – – Head and Neck Surgery.
Sudden sensorineural hearing loss, which affects approximately 4,000 Americans each year, is hearing loss of 30 dB or more that develops over a span of several hours to three days. While the spontaneous recovery rate is high – – 30 percent to 60 percent of patients may experience recovery within two weeks – – little is known about the exact cause.
In the study of 121 patients, 45 percent recovered within three months after 10 days of oral corticosteroid therapy. Of the group who received oral corticosteroid therapy, more than 78 percent fully recovered within one month, according to researchers at Catholic University of Korea's College of Medicine.
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January 30: Cancelled Plans, Agitation Felt By Caregivers Of Children Suffering From Otitis Media, Medical News Today
The burden of caring for a child suffering from otitis media (acute middle ear infections) has such an impact on a caregiver’s quality of life that the caregiver often becomes nervous, agitated, and is forced to change their day’s activities, according to a new study published in the February 2007 issue of the medical journal Otolaryngology – Head and Neck Surgery.
The results, drawn from the responses of over 150 families with children suffering from otitis media, measures the quality of life (QOL) and functional health status (FHS) of caregivers when a child is stricken by otitis media. The study’s authors found that in over half the cases (52 percent), caregivers reported feeling nervous, agitated, or irritable part of the time their child was sick, while an additional 12 percent reported these feelings all of the time. Other negative effects reported include loss of sleep by the caregiver and forced changes in daily family activities. Additionally, 12 percent said they had to miss substantial time at work.
Otitis media is a common infection or inflammation of the middle ear experienced by 75 percent of children before their third birthday. It is estimated that the medical costs and wages lost because of otitis media amounts to $5 billion annually in the United States alone.
Based on these findings, the authors say their conclusions validate two new surveys for determining the impact of otitis media on a caregiver’s quality of life, information that should be considered when assessing the impact of otitis media on children.
Otolaryngology – Head and Neck Surgery is the official medical journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF).
The authors of the study are Marina Boruk, MD; Paul Lee; Yelena Faynzilbert; and R.M. Rosenfeld, MD, MPH. They are associated with the Department of Otolaryngology at SUNY-HSC/Brooklyn in New York.
The study coincides with Kids E.N.T. Month, a program spanning February that aims to educate and foster new awareness of issues in otolaryngology and care that affect parents, children and their physicians. More information on Kids E.N.T. Month can be found at entnet.org/kidsent/.
About the AAO-HNSF:
The American Academy of Otolaryngology Head and Neck Surgery Foundation (entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission is: "Working for the Best Ear, Nose, and Throat Care."
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