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April 2008 News Archives
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April 1: Botox May Move From Face to Brain, Study in Rats Says, Bloomberg News
By Elizabeth Lopatto
April 1 (Bloomberg) -- Botulinum neurotoxin type A, sold as Allergan Inc.'s Botox remedy for wrinkles, can move from its injection site to the brain, a study shows.
Scientists injected rats' whisker muscles with botulism toxin. Tests of the rodents' brain tissue found that botulism had been transported to the brain stems, the researchers said in the Journal of Neuroscience published April 2.
Botox is Allergan's biggest product, with $1.21 billion in sales last year. The drug, approved in 1989, became fashionable among aging celebrities seeking to smooth facial wrinkles and is used to treat some neurological disorders. The U.S. Food and Drug Administration is investigating whether patients contracted botulism, a muscle-weakening illness, from Botox and Myobloc, a product from Solstice Neurosciences Inc.
``The idea that there could be some transmission of this to the central nervous system needs to be followed up,'' said Mathew Avram, the director of Massachusetts General Hospital's Dermatology, Laser and Cosmetic Center, in Boston, in a telephone interview today. ``But this treatment has been used on millions of people for years, and we're not seeing major central nervous system uses with it.''
Botulism neurotoxin can disrupt nerve cells' ability to communicate and may change spinal cord circuitry, the authors wrote in the study.
Rodents, Not Humans
Mouse and rat physiology is different from that of humans, so the results may not predict what happens in people, Avram said. He wasn't involved in the study.
The study isn't conclusive, and because it contradicts previous findings, more work is necessary, according to an Allergan spokeswoman. The company is based in Irvine, California.
``The authors used a laboratory preparation of botulinum toxin and did not use Botox, and data suggest that different preparations of botulinum toxin react differently in both the laboratory and in clinical practice,'' said the spokeswoman, Caroline Van Hove, in an e-mailed statement.
Myobloc is botulinum neurotoxin type B, a different type of botulinum than studied, said Edgar Salazar-Grueso, chief medical officer of Solstice Neurosciences, in a telephone interview today.
``We are aware from monkey studies already published that toxin A migrates more than B,'' Salazar said. ``Monkeys are more like humans than rodents, so these findings we're observing are consistent.''
FDA Evaluation
Scientists injected botulism toxin into one side of the hippocampus in each rodent brain, and into their superior colliculus, a visual center. From one side of the hippocampus, the toxin migrated to the opposite. From the visual center, the drug went to the animals' eyes.
The effects of the injection into the hippocampus were still present six months later, the scientists wrote.
The FDA is evaluating reports of breathing difficulties and death after use of Botox and Myobloc, according to a posting in February on the agency's Web site. Many of the most serious cases involved children who received the injections to treat arm and leg spasms associated with cerebral palsy, a use not approved by the FDA.
Prescribing literature for Botox and Myobloc now carries warnings about the risk of breathing and swallowing difficulties in patients with neuromuscular disorders. The FDA said the new data suggest that life-threatening side effects may occur in patients with other conditions, including children with cerebral palsy.
Large Doses
Higher doses of Botox are injected to treat limb spasms in children with cerebral palsy in about 60 countries. Some U.S. doctors use it for this purpose, though Allergan doesn't market it in the U.S. for the unapproved use. A typical cosmetic dose is about 10 times less than a dose for cerebral palsy, Avram said.
``The FDA was investigating Botox in situations where large amounts were used,'' Avram said. ``Those tend to be very young children with massive doses. I don't know that this study relates to that.''
Botulism, which can also be spread through contaminated food or wounds, is caused by a bacterium called clostridium botulinum, according to the U.S. Centers for Disease Control and Prevention, in Atlanta. About 110 cases are reported in the U.S. each year.
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April 1: New Therapies Fight Phantom Noises of Tinnitus, The New York Times
By KATE MURPHY
Modern life is loud. The jolting buzz of an alarm clock awakens the ears to a daily din of trucks idling, sirens blaring, televisions droning, computers pinging and phones ringing — not to mention refrigerators humming and air-conditioners thrumming. But for the 12 million Americans who suffer from severe tinnitus, the phantom tones inside their head are louder than anything else.
Often caused by prolonged or sudden exposure to loud noises, tinnitus (pronounced tin-NIGHT-us or TIN-nit-us) is becoming an increasingly common complaint, particularly among soldiers returning from combat, users of portable music players, and aging baby boomers reared on rock ’n’ roll. (Other causes include stress, some kinds of chemotherapy, head and neck trauma, sinus infections, and multiple sclerosis.)
Although there is no cure, researchers say they have never had a better understanding of the cascade of physiological and psychological mechanisms responsible for tinnitus. As a result, new treatments under investigation — some of them already on the market — show promise in helping patients manage the ringing, pinging and hissing that otherwise drives them to distraction.
The most promising therapies, experts say, are based on discoveries made in the last five years about the brain activity of people with tinnitus. With brain-scanning equipment like functional magnetic resonance imaging, researchers in the United States and Europe have independently discovered that the brain areas responsible for interpreting sound and producing fearful emotions are exceptionally active in people who complain of tinnitus.
“We’ve discovered that tinnitus is not so much ringing in the ears as ringing in the brain,” said Thomas J. Brozoski, a tinnitus researcher at Southern Illinois University School of Medicine in Springfield.
Indeed, tinnitus can be intense in people with hearing loss and even those whose auditory nerves have been completely severed. In the absence of normal auditory stimulation, the brain is like a driver trying to tune in to a radio station that is out of range. It turns up the volume trying but gets only annoying static. Richard Salvi, director of the Center for Hearing and Deafness at the State University of New York at Buffalo, said the static could be “neural noise” — the sound of nerves firing. Or, he said, it could be a leftover sound memory.
Adam Edwards, a 34-year-old co-owner of a wheel repair shop in Dallas, said he developed tinnitus four years ago after target shooting with a pistol. “I had all the risk factors,” he said. “I grew up hunting, I played drums in a band, I went to loud concerts, I have a loud work environment — everything but living next to a missile launch site.” His tinnitus, which he described as a “computer beeping” sound, was so intense and persistent that he needed sedatives to sleep at night.
Mr. Edwards says he has gotten relief from a device developed by an Australian audiologist, which became widely available in the United States last year. Manufactured by Neuromonics Inc. of Bethlehem, Pa., it looks like an MP3 player and delivers sound spanning the full auditory spectrum, digitally embedded in soothing music.
Similar to white noise, the broadband sound, tailored to each patient’s hearing ability, masks the tinnitus. (The music is intended to ease the anxiety that often accompanies the disorder.) Patients wear the $5,000 device, which is usually not covered by health insurance, for a minimum of two hours a day for six months. Since completing the treatment regimen last year, Mr. Edwards said his tinnitus had “become sort of like Muzak at a department store — you hear it if you think about it, but otherwise you don’t really notice.”
A small, company-financed study in the journal Ear & Hearing in April 2007 indicated that the Neuromonics method was 90 percent successful at reducing tinnitus. A larger study is under way to determine its long-term effectiveness.
Anne Howell, an audiologist at the Callier Center for Communication Disorders at the University of Texas at Dallas, said the Neuromonics device was a big improvement over older sound therapies that required wearing something that looked like a hearing aid all the time and took 18 to 24 months.
“The length of time was discouraging for many patients,” she said. “And a lot of them told me that wearing something that looks like a hearing aid would cause a problem in their professional life.”
Other treatments showing promise include surgically implanted electrodes and noninvasive magnetic stimulation, both intended to disrupt and possibly reset the faulty brain signals responsible for tinnitus. Using functional M.R.I. to guide them, neurosurgeons in Belgium have performed the implant procedure on several patients in the last year and say it has suppressed tinnitus entirely.
But the treatment is controversial. “It’s a radical option and not proven yet,” said Jennifer R. Melcher, an assistant professor of otology and laryngology at Harvard Medical School.
The magnetic therapy, similar to treatments used for depression and chronic pain, involves holding a magnet in the shape of a figure eight over the skull. Clinicians use functional M.R.I. to aim the magnetic pulses so they reach regions of the brain responsible for interpreting sound. Patients receive a pulse every second for about 20 minutes. “It works for some people but not for others,” said Anthony Cacace, professor of communication science and nerve disorders at Wayne State University in Detroit. Since tinnitus has so many causes, Dr. Cacace said, the challenge now is to find out which “subsets of patients benefit from this treatment.”
Researchers in Brazil have published a study indicating that a treatment called cranial-sacral trigger point therapy can relieve tinnitus in some head and neck trauma cases by releasing muscles that constrict hearing and neural pathways.
And drugs intended to treat alcoholism, epilepsy, Alzheimer’s and depression that alter levels of various neurotransmitters in the brain like serotonin, dopamine and gamma-aminobutyric acid have quieted tinnitus in some published animal and human studies.
“We’ve never been so hopeful,” said Dr. Salvi, of SUNY Buffalo, “of finding treatments for a disorder that haunts people and follows them everywhere they go.”
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April 1: No risk factors, but they got cancer anyway, The Dallas Morning News
Doctors want to know why sometimes cancer just seems to happen
By KATHLEEN GREEN / Special Contributor to The Dallas Morning News
When making a diagnosis, doctors consider a patient's age, lifestyle choices and family history.
But sometimes, cancers crop up in patients who don't fit the bill – they may even have no risk factors.
"A lot of cancers are increasing in frequency and in incident," says Dr. Mark Engleman, a radiation oncologist with Baylor Regional Medical Center at Plano. "We know we're doing something [in our daily living], but we're not sure what it is. The easy stuff is the smoking and the drinking. But clearly those are not the only risk factors because, otherwise, people who are nonsmokers and nondrinkers would not be getting this disease as commonly as they are."In just the last five years, ear, nose and throat specialist Kevin Lunde says doctors in his specialty have noticed a dramatic increase in head and neck cancers, including mouth and throat cancers in nonsmokers.
"We've all begun to be made more aware and be more aggressive in evaluating patients' mouth and throat complaints to make sure we're not missing cancers, because people are getting these cancers without the typical risk factors," says Dr. Lunde, also with Baylor Plano.
Specialists such as Dr. Lunde urge primary care doctors to thoroughly investigate symptoms to detect problems early.
"In the past, we would typically see [cancers of the mouth and throat] in people over 50 or 60 years of age who have a long smoking history," he says. "And now I have people in their 30s and 40s with no smoking history getting significant cancers."
One theory about why head and neck cancers are mysteriously appearing: the sexually transmitted human papilloma virus, which is normally associated with cervical cancer in women, he says.
And while vocal-cord cancer symptoms are noticeable, that's not necessarily true with cancer of the tonsils or at the back of the tongue, he says.
"Some of these patients are coming in with a neck mass already where it travels to the glands in their neck," he says. "It can get fairly big before they start to having any sort of throat pain, trouble swallowing or change in the voice."
Warning signs for head-neck cancer are: a lump in the neck, a change in the voice, any kind of growth in the mouth, spitting up blood, a persistent earache, any trouble swallowing or, for skin cancers, any change in a skin lesion, he says.
"We're just no longer surprised about seeing cancer in younger patients who do not have that smoking history," he says.
Lung specialists, too, are growing more concerned with increasing numbers of young cancer patients. Dr. Joan Schiller, chief of the division of hematology oncology and deputy director of the cancer center at the UT Southwestern Medical Center, says there are theories about the unusual increase, including air pollution.
"It seems to be higher in big cities than it is out in the country," says Dr. Schiller. "And then there is some suggestion that women nonsmokers in particular are more likely to get lung cancer than men. The hypothesis is that it may have something to do with estrogen," which may act as a tumor growth factor.
Dr. Schiller estimates that about 200,000 people in the U.S. are diagnosed with lung cancer each year, of which about 15 percent of the cases are not smoking-related.
"If someone, regardless if they're a smoker or not, comes down with a chronic cough that doesn't seem to go away even with some type of antibiotic treatment, I would really push for an X-ray or a CT scan," says Dr. Schiller.
And for women without any sort of family breast-cancer history, they, too, need to take heed. Early detection is critical because it improves the prognosis, says Dr. Anita Chow, surgical oncologist at Baylor All Saints Medical Center at Fort Worth.
"Therefore, every woman should have a baseline mammogram at the age of 40, and then annually thereafter," says Dr. Chow.
Kathleen Green is a Plano freelance writer.
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April 11: HPV-related oral cancers rise among younger men, The Baltimore Sun
Hopkins doctor credited with linking tumors and sexually transmitted virus
Dr. Maura Gillison, a Johns Hopkins oncologist, found that HPV causes some head and neck cancers, as well as cervical cancer.
The sexually transmitted virus that causes cervical cancer in women has now been linked to an uptick of throat, tonsil and tongue cancers - in a younger and healthier group of patients than doctors have ever seen before.
These head and neck cancers were once the scourge of older men - mostly the result of lifetimes of heavy smoking and drinking. The treatments often left victims disfigured.
But with those cases on the decline, doctors are seeing a new group of victims. They're men in their 40s, and even 30s, whose cancer is brought on by the increasingly common human papillomavirus (HPV). It's an infection that more than half of Americans will encounter during their lifetimes. And researchers now believe that the increase in certain oral cancers can be traced to the spread of the virus through oral sex.
New studies suggest that HPV-related oral cancer cases are on pace to eventually surpass cases of cervical cancer in the United States, which strikes about 11,000 women each year. And many doctors do not realize that they should be on the lookout for oral cancer in younger patients.
"It just kind of rocks the whole paradigm," said Dr. Maura Gillison, a Johns Hopkins oncologist who is credited with making the link between HPV and oral cancers. "Everyone thinks of the long-term smoker, the long-term drinker. Now we're seeing the movers and shakers in the prime of life."
Gillison and others say they hope an HPV vaccine designed to protect girls and young women against cervical cancer will be approved for boys and tested for head and neck cancers, which are more likely to affect men than women.
Researchers say changing sexual behavior probably accounts for the explosion of HPV-related oral cancers. In a study published last year in The New England Journal of Medicine, Gillison and colleagues found the strongest link in patients with larger numbers of lifetime sex partners.
The sexual revolution of the 1960s made it more acceptable to have more sex partners, she and others said. And, if the AIDS scare of the 1980s persuaded many to have safer sex, the caution didn't always extend to oral sex. The bottom line: more HPV-related oral cancers.
A reluctance to discuss oral sex may be why the public knows so little about the link between HPV and head and neck cancers.
There is plenty of open talk about preventing cervical cancer nowadays, including commercials that tout the blockbuster HPV vaccine with girls chanting about becoming "One Less." But there's still more of a taboo when it comes to talking about oral sex.
"The public is unaware of this," said Dr. Erich Sturgis, a head and neck surgeon at The University of Texas M.D. Anderson Cancer Center who has studied HPV. "It's just starting to filter out."
It doesn't even occur to some primary-care doctors that their patients younger than 60 might have developed oral cancer, but researchers say a lingering sore throat or a lump in the neck could be symptoms of the disease and should be checked out.
These cancers remain relatively rare, despite a 5 percent increase in cases each year since 2000. Estimates put cases of HPV-associated head and neck cancers at 6,000 per year - and cervical cancer cases at fewer than 11,000.
Debbie Roffman, a human sexuality educator at Park School and author of Sex and Sensibility: The Thinking Parent's Guide to Talking About Sex, discusses risky behaviors with her students, some of whom are in middle school. But sometimes it's hard to get the message through, especially when students are sure those behaviors won't hurt them.
"They're not going to be as focused on invisible things like germs and long-developing things like cancer that are way off in the future," she said.
Gillison said everyone involved - from pre-teens to primary-care doctors - must change their perception of who is at risk. Doctors taking medical histories typically ask about smoking- and alcohol-related behaviors, but she said they should ask about sexual history, too.
"Now most of us are at risk, because humans are sexual beings," she said.
The rise of HPV-related head and neck cancers is not just a U.S. phenomenon. Swedish researchers who re-examined samples from the 1970s have found that 28 percent of oral tumors were HPV-positive. In tumors from 2000 to 2002, HPV-positive samples jumped to 68 percent.
In a study by Gillison and others last year, 72 percent of certain oral cancers were HPV-positive.
HPV is typically spread through sexual contact. While many women will have HPV at some point in their lives, they frequently have no symptoms and the virus usually goes away on its own. Sometimes, HPV lingers and becomes cancer - a process that can take decades.
Doctors are familiar with this progression because pre-cancerous lesions are often caught during Pap tests. But they don't know much about how progression occurs in the throat and mouth.
Gillison and her colleagues say HPV-related oral cancers appear to be distinct from those not associated with the sexually transmitted infection and appear to respond differently to treatment.
Two years after diagnosis, 95 percent of those with HPV-positive head and neck cancers were alive compared with 62 percent with HPV-negative cancers, research shows.
Even so, the treatment can have serious and long-lasting side effects. Some patients end up disfigured; others have difficulty speaking or swallowing. Gillison said those with HPV-positive tumors might be able to survive with less-damaging treatments.
Meanwhile, the HPV vaccine has been a financial boon for Merck & Co., the maker of Gardasil, the three-dose vaccine approved in the United States in 2006 for females ages 9 through 26. Doctors recommend vaccinating girls before they become sexually active and can be exposed to the virus.
Merck sold $1.5 billion worth of Gardasil last year around the world. GlaxoSmithKline is seeking U.S. approval for a competing drug called Cervarix.
Neither vaccine is approved for males. Both companies are studying whether it is safe in boys and whether it would prevent genital warts and rare cancers of the penis and anus. But neither has plans to study whether the vaccine would play any role in the prevention of HPV-linked oral cancers.
"Cervical cancer is really the focus," said Liad Diamond, a GlaxoSmithKline spokeswoman.
Experts said they think researchers will find the vaccine works on HPV throughout the body.
"The way the vaccine works, there's no reason to think it wouldn't protect against oropharanyx [tonsil, tongue and throat] cancer as it does cervical cancer," Sturgis said.
Dr. Aimee Kreimer, an epidemiologist at the National Cancer Institute in Bethesda, said that, theoretically, the vaccine should work on HPV anywhere in the body but such discussion is premature.
"Before recommending the vaccine to men, it's crucial to determine if the vaccination works to prevent infection in men," she said.
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April 13: Mouth test could predict lung cancer, study finds, Reuters
WASHINGTON (Reuters) - Damage to cells lining the mouth can predict similar damage in the lungs that eventually leads to lung cancer in smokers, U.S. researchers reported on Sunday.
They hope it may be possible to some day swab the mouths of smokers to predict who is developing lung cancer -- saving painful and dangerous biopsies of the lung.
The process may also lead to tests that will predict other cancers, said Dr. Li Mao, an expert in head, neck and lung cancer at the University of Texas M.D. Anderson Cancer Center in Houston.
"Our study opens the door to enhancing our ability to predict who has higher probability of getting tobacco-related cancers," Mao said in a statement. "Not only lung cancer, but pancreatic, bladder and head and neck cancers, which also are associated with tobacco use."
Smoking is the leading cause of lung cancer, but only about 10 percent of smokers ever get it. It causes few symptoms until it is advanced, which means patients are rarely diagnosed or treated until it is too late for a cure.
Mao's team wanted to find a way to monitor patients taking a drug -- the COX-2 inhibitor celecoxib, sold by Pfizer under the brand name Celebrex -- in the hopes of preventing lung cancer.
They looked at two genes known to help prevent the development of cancer -- p16 and FHIT. "There is substantial damage (to the two genes) long before there is cancer," Mao said.
Speaking to a meeting of the American Association for Cancer Research in San Diego, they said they looked for specific damage to these genes in both lung samples and mouth samples from 125 long-time smokers.
"We are talking about just a brushing inside of the cheek to get the same information we would from lung brushings obtained through bronchoscopy," said Dr. Manisha Bhutani, who works with Mao.
The p16 gene was shut down via a process called methylation in the lungs of 23 percent of the volunteers, while FHIT was affected in 17 percent. In the mouth, p16 was silenced in 19 percent of the smokers and FHIT in 15 percent of them.
In 95 percent of those whose genes were affected, they were affected in both the mouth and the lung, Mao and Bhutani said.
This would make an easier test for pre-lung cancer than having to access the lung, the researchers said.
This could be useful in monitoring for lung cancer and also looking to see if prevention measures might work.
"This could have strong implications for further lung cancer prevention trials," they wrote in a summary submitted to the conference.
At least one other group is working on a saliva test for breast cancer, one that looks for a mutated version of the HER-2 protein linked to some breast cancers.
(Reporting by Maggie Fox)
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April 15: Help For Snoring Hubby? Share The Bed, WebMD
We've all experienced it, or heard about someone who has. You drift off to sleep and next thing you know, it sounds like a lumberyard. It's not a nightmare, it's your husband snoring in bed.
What do you do? A new study of married couples shows that the wife holds the key to helping the husband stay on track when it comes to treating sleep apnea.
Researchers from Rush University Medical Center in Chicago looked at 10 men who were diagnosed with obstructive sleep apnea and their non-snoring wives.
Obstructive sleep apnea is the term for the most common type of breathing interruption while sleeping. What usually happens is the airway collapses, causing blocked or shallow breathing, along with the sound of snoring.
The Snoring Study's Findings
The couples slept together for two nights in a sleep lab to get a baseline before being treated. Then for two weeks at home the men were hooked up to a breathing device that delivers CPAP, which is known as continuous positive airway pressure.
The study showed that the treatment went better when men slept in the same bed as their wives.
- When couples slept together in the same bed the men used the breathing device four hours or more 74 percent of the time.
- The shared-bed couples both had fewer wake-ups.
- When the women left the bed, men only used the breathing device four hours or more 43 percent of nights recorded.
- The women who left the bed woke up more, even when the men were breathing soundly and not snoring.
Study researcher Rosalind Cartwright of Rush University Medical Center in Chicago urges more research, with longer follow-up times.
In a news release Cartwright says the findings suggest that a married couple be educated together and treated as a unit by health professionals who diagnose one of the partners with obstructed sleep apnea.
Nation of Snorers?
Snoring was prevalent in the U.S. A. 2005 poll "Sleep in America" from the National Sleep Foundation. Pollsters surveyed 1,032 adults by telephone. Here's what they found:
- 67 percent of respondents said that their significant other snores.
- More than half said their snoring disturbs the partner's sleep.
- 31 percent of those surveyed said that the snorer forces the other partner to sleep in a separate bedroom, or to use earplugs.
Excessive snoring is one of the symptoms of obstructive sleep apnea or OSA, which affects millions of Americans. No one needs to tell you that a rocky night of sleep can be hard on a marriage. Sleep apnea can also be linked to hypertension, depression, stroke, diabetes, sexual dysfunction, and heart disease.
The findings of the new small study are published in the April 15 edition of the Journal of Clinical Sleep Medicine.
By Kelley Colihan
Reviewed by Louise Chang
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April 16: Antibiotics Don't Help Much in Most Sinus Infections, US News & World Report
For mild sinusitis, forgoing drug treatment makes sense, experts conclude
By January W. Payne
People with mild sinus infections may be best off toughing it out rather than turning to an antibiotic, which research increasingly suggests isn't likely to speed their recovery. Two studies in recent weeks, including one published today, have reached that basic conclusion.
What the new research shows is that "observing patients is an option if the patient has mild illness," says Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y. He emphasizes that the findings don't apply to patients with chronic sinusitis or to those who have more serious illness—indicated by, for instance, a fever higher than 101 degrees or severe pain—because those patients have been excluded from most studies in which some people don't get antibiotics.
The latest research, by the Cochrane Collaboration, reviewed dozens of such studies. (Last month, a separate study appeared in The Lancet.) The Cochrane group, which produces reviews of healthcare interventions, found that antibiotics may have a "small treatment effect" in patients with mild sinusitis and symptoms for more than seven days. But, the report notes, eight out of 10 patients improve without antibiotics within two weeks, so "clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects." Any benefit gained by prescribing medicine, the report continues, may be "overridden by the negative effects of antibiotics, both on the patient and on the population in general."
Doctors who routinely treat sinusitis aren't surprised by the group's findings. "I think that most illnesses in general tend to get better on their own," says Stanley Chia, a staff otolaryngologist at Washington Hospital Center in Washington, D.C. Forty million Americans get sinusitis every year, according to the Mayo Clinic; triggers include allergies, bacteria, and viruses like those that cause the common cold. Antibiotics are effective only in treating bacterial illnesses.
Acute sinus infections may be routinely overtreated. The March Lancet study concluded that antibiotics aren't needed even if a patient reports symptoms for longer than seven to 10 days. And a study published in the Journal of the American Medical Association in December found that neither an antibiotic nor a nasal steroid was effective in treating acute sinusitis. The American Academy of Otolaryngology-Head and Neck Surgery—a group of ear, nose, and throat specialists—issued adult sinusitis treatment guidelines in September that suggest clinicians watch patients with mild bacterial sinus infections for up to seven days before prescribing antibiotics, according to Rosenfeld, who chaired the committee that produced the guidelines.
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April 7: Lack of sleep takes a toll on children, The Boston Globe
Sleep is not expendable.
When children routinely don't get enough sleep or when the sleep they get is disrupted, they are at higher risk for obesity, learning difficulties, and behavioral problems, according to articles in a special issue of the Archives of Pediatrics and Adolescent Medicine. Parents sometimes respond to early troubles getting their children to fall asleep or stay asleep with tactics -- such as nighttime snacks -- that work for a while but lead to other problems later.
"Whenever you have disrupted sleep at night in children, it can adversely affect their attention, neurocognition, and memory in the daytime," Dr. Sanjeev Kothare of the Children's Hospital Boston sleep center said in an interview. He was not involved in the Archives studies.
Sleep deprivation and obesity in children have been considered together in the past, but Dr. Elsie Taveras of Harvard Medical School tracked children from infancy, before they were overweight, to preschool age to see if there was a link.
She found that children who slept less than 12 hours per day were twice as likely to be overweight at age 3 than children who slept longer, even when how much television they watched was taken out of the equation. (Watching a lot of TV combined with not sleeping very much did appear to lead to higher weight in children, she wrote.)
"It really falls in line in general with the epidemiology of obesity," Dr. Christopher Landrigan of Brigham and Women's Hospital, who was not involved in the research, said in an interview. "Over the past decade there's been an increase in obesity at the same time the amount of sleep adults and children is falling in tandem, compared to the 1960s and '70s. It's causing real concern about the ill effects of sleep deprivation."
Another study of Dutch children said that lack of sleep during childhood may be a warning flag for emotional problems, attention difficulties, and aggression later in life. Short sleepers may not function as well during the day, having difficulty with other people or getting into accidents, leading to emotional and behavioral trouble, the authors suggest.
Unlike adults, when children don't get enough sleep, they can become hyperactive -- so much so their behavior can be confused with attention deficit disorder. Many children with ADD also have sleep problems, another study points out.
Good sleep hygiene -- bedtime rituals, a calm environment, allowing a child to learn how to fall back asleep alone -- can help. Sleep apnea or other physical causes should be treated or ruled out, Kothare and Landrigan said. Parents who stay with their children until they fall asleep or bring food when they awake during the night can interfere with good sleep patterns.
"A good night's sleep will lead to good daytime function in society and in school," Kothare said.
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April 7: Buzz Kill: Scientists Aim to Stop Ringing Ears, ABC News
Tinnitus Has No Cure; Some Sufferers Found Relief in New Treatments
By LAURA ZACCARO, CATHY BECKER and IMAEYEN IBANGA
Imagine waking up daily and hearing the sound of a whistling tea pot or having constant ringing in your ears that never goes away.
Fifty million Americans deal with these inescapable sounds, which can make life difficult, according to the American Tinnitus Association.
Tinnitus sufferers hear a perception of sound in their ears or head where no external source is present.
"The sounds will be a hissing sound, SSS ringing sound," said Dr. Richard Salvi, of the University of Buffalo. "There's no way to escape from it."
Tinnitus has become more common with the introduction of MP3 players and even combat veterans have become extremely sensitive to noise.
Researchers still are unsure what causes the ringing sensation, though they suspect it can be brought on by exposure to loud noises, which damage delicate hair cells in the inner ear.
But scientists now are learning that for some, tinnitus does not originate in the ear, but rather, in the brain. As researchers try to find a cure for the condition, about 2 million tinnitus sufferers are debilitated so badly, they are unable to function on a normal day-to-day basis, according to the ATA.
The constant noise can take an emotional toll.
"I thought of suicide constantly. That was the only way I could eliminate my torture," said Carol Brooks, whose problems began after a car accident.
Tinnitus Treatments
Eventually Brooks found relief with a sound generator, which makes tinnitus less noticeable and trains the brain to ignore the sounds.
"I was thrilled. Two-and-a-half months into the treatment I was able to walk out on the street and tolerate the wind, "Brooks aid.
The sound generator is just one of the ways to deal with the condition. Another treatment requires patients to wear what looks like an MP3 player for two hours day. The device, which is called Neuromonics oasis, delivers a special sound whose frequency is personalized to a patient's hearing loss.
The idea behind it is that it masks tinnitus and helps to change the way the brain hears the noise.
Tinnitus creates two distinct problems for the patient, said "Good Morning America" medical contributor Marie Savard. One is the sound and the other is the emotional response that occurs because of that sound.
The Oasis tries to treat both problems at once, she added.
"They hear a specially created stimulus designed to interact with or interrupt the sound the patient hears and that stimulus is camouflaged in music, making the process more pleasant for the patient," Savard said.
With ongoing treatment, technicians will adjust the stimulus and hopefully decrease the brain's sensitivity to the tinnitus sound, Savard said.
"Within two months my sensitivity to loud sounds and music went down incredibly," said Michael Celotto, who began having hearing difficulties after playing with his rock band one night.
Savard said it's important to note up to 90 percent of all tinnitus patients have some level of hearing loss. So one of the first things a doctor should do is assess a patient for correctable hearing loss and treat it with a hearing aid or a cochlear implant, if appropriate.
"We find that increasing a patient's hearing can alleviate some tinnitus symptoms," she said.
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April 13: Mouth test could predict lung cancer, study finds, Reuters
WASHINGTON (Reuters) - Damage to cells lining the mouth can predict similar damage in the lungs that eventually leads to lung cancer in smokers, U.S. researchers reported on Sunday.
They hope it may be possible to some day swab the mouths of smokers to predict who is developing lung cancer -- saving painful and dangerous biopsies of the lung.
The process may also lead to tests that will predict other cancers, said Dr. Li Mao, an expert in head, neck and lung cancer at the University of Texas M.D. Anderson Cancer Center in Houston.
"Our study opens the door to enhancing our ability to predict who has higher probability of getting tobacco-related cancers," Mao said in a statement. "Not only lung cancer, but pancreatic, bladder and head and neck cancers, which also are associated with tobacco use."
Smoking is the leading cause of lung cancer, but only about 10 percent of smokers ever get it. It causes few symptoms until it is advanced, which means patients are rarely diagnosed or treated until it is too late for a cure.
Mao's team wanted to find a way to monitor patients taking a drug -- the COX-2 inhibitor celecoxib, sold by Pfizer under the brand name Celebrex -- in the hopes of preventing lung cancer.
They looked at two genes known to help prevent the development of cancer -- p16 and FHIT. "There is substantial damage (to the two genes) long before there is cancer," Mao said.
Speaking to a meeting of the American Association for Cancer Research in San Diego, they said they looked for specific damage to these genes in both lung samples and mouth samples from 125 long-time smokers.
"We are talking about just a brushing inside of the cheek to get the same information we would from lung brushings obtained through bronchoscopy," said Dr. Manisha Bhutani, who works with Mao.
The p16 gene was shut down via a process called methylation in the lungs of 23 percent of the volunteers, while FHIT was affected in 17 percent. In the mouth, p16 was silenced in 19 percent of the smokers and FHIT in 15 percent of them.
In 95 percent of those whose genes were affected, they were affected in both the mouth and the lung, Mao and Bhutani said.
This would make an easier test for pre-lung cancer than having to access the lung, the researchers said.
This could be useful in monitoring for lung cancer and also looking to see if prevention measures might work.
"This could have strong implications for further lung cancer prevention trials," they wrote in a summary submitted to the conference.
At least one other group is working on a saliva test for breast cancer, one that looks for a mutated version of the HER-2 protein linked to some breast cancers.
(Reporting by Maggie Fox)
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April 24: The Mouthwash Debate, Newsweek
Does it cure bad breath? What you should know.
By Karen Springen
For years medical consultant Gerard Einhorn, now 54, suffered from breath so bad that he avoided getting too close to clients and family members and even covered his mouth when he spoke. "You're going to sleep at night and your wife is next to you and says, 'Your breath is bad. Did you brush your teeth?'" he says. Today, thanks to good oral health habits, including an alcohol-free mouthwash, he has conquered his problem.
But millions of other Americans are still fighting breath that smells like rotten eggs. Should they turn to mouthwash too? And if so, should they use traditional alcohol-containing ones, like Listerine, or should they use alcohol-free ones, like Crest Pro-Health? After all, the original, gold-colored Listerine contains a scary-sounding 26.9 percent alcohol—twice the amount in wine, and more than five times the amount in beer.
Critics of alcohol-containing products say that alcohol dries the mouth, which could potentially worsen breath. (Think of dry, stinky morning breath after a night of drinking.) Listerine says its product does not dry the mouth when used as directed. Even if that's true, say critics, it's better to use any of the growing number of alcohol-free products, from Crest Pro-Health to Tom's of Maine to ACT. After all, why expose kids and alcoholics to a potentially toxic product? Meanwhile, Listerine officials say their century-old product is the most studied mouthwash and boasts the American Dental Association's seal of acceptance for helping reduce plaque and gingivitis. They say they're not working on an alcohol-free Listerine for adults, although just this month the company introduced an alcohol-free cavity-fighting, fluoride-containing product for kids called Listerine Smart Rinse.
An estimated 25 percent of Americans suffer from chronic bad breath, called halitosis. Many more suffer from it occasionally (say, post-onions) or are at risk of it from periodontal disease. About 70 percent of Americans suffer from some periodontal disease—a problem, since cavities and swollen gums are a good place for foul-smelling bacteria to hang out. Offensive mouth odor typically comes from bacteria in the mouth that release sulfur compounds—hence the rotten egg smell.
Why could alcohol be bad for breath? "It's well known that alcohol is a drying agent," says Matt Doyle, a senior scientist for Procter & Gamble, manufacturer of alcohol-free Crest Pro-Health and alcohol-containing Scope. "If you dry out the tissues, the smelly compounds that the bacteria produce are no longer naturally washed away, and you get a pungent experience." Dr. Harold Katz, a dentist who makes alcohol-free TheraBreath mouthwash, agrees: "The drier your mouth, the less saliva you have, which is nature's way of keeping your breath fresh."
"It is true that alcohol, at high concentrations, contributes to dry mouth, which exacerbates bad breath and the growth of germs," says Laura Brinker, a spokeswoman for Procter & Gamble. "Alcohol draws moisture out of the tissues in your mouth, and also slows salivary flow … Since saliva is limited, the bacteria is not being diluted or washed out. This means bad-breath germs and other germs become concentrated in the mouth." (John Coelho, director of clinical research for Johnson & Johnson Consumer & Personal Products, which makes Listerine, notes that a study at the State University of New York at Buffalo on people with dry mouths found that using Listerine even three times a day didn't make their mouths any drier. Without the alcohol, the active ingredients don't "penetrate" the plaque as well, says Coelho.)
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